A standoff between a major insurer and a local healthcare network could leave hundreds of Hudson Valley residents scrambling to find new providers for hospital and home care services.
According to officials at both companies, insurers CDPHP and the Dutchess-based Health Quest network have deadlocked on efforts to hammer out a new reimbursement deal. A current agreement will expire on April 15. Patients who have filed a claim within the past 90 days will still be able to use Health Quest providers for follow-up care until May 18 under “continuity of care” regulations.
After that, if the dispute is not resolved, Health Quest-affiliated facilities and services will cease to accept CDPHP insurance for hospitalization and home health services. CDPHP members’ access to family doctors and other physicians affiliated with the health network will not be affected. Health Quest will also continue to accept CDPHP members for emergency medical services.
The impasse could impact as many as 400 CDPHP members in the Hudson Valley who have current claims and many more who will be unable to use Health Quest services in the future if the companies do not come to an agreement.
Both sides said that the dispute was over reimbursement rates between the insurer and the health network which runs Northern Dutchess Hospital, Vassar Brothers Medical Center and Putnam Hospital Center.
“The reimbursement rates are not reflective of the cost of delivering high quality medical care,” said Health Quest spokesman John Nelson this week.
But a spokeswoman for CDPHP said that the impasse was part of a bigger issue as provider networks like Health Quest consolidate and take up larger and larger shares of the local health marketplace. CDPHP spokeswoman Alessandra Skinner said consolidation was driving healthcare costs to the point where her company was paying an unsustainable 33 percent of every premium dollar on hospital services.
“As hospitals consolidate, there’s less competition,” said Skinner. “And as consolidated groups they can use their negotiating power to demand higher and higher reimbursement rates. We can’t let that continue.”