CDPHP Customer Service 24/7 — Expert Guide for Members and Providers

Overview and context

Capital District Physicians’ Health Plan (CDPHP) is a not-for-profit health plan founded in 1984 to serve the Capital Region of New York. As a regional insurer with Medicare Advantage, commercial, individual, and Medicaid products, CDPHP emphasizes continuous access to care; that emphasis is why 24/7 customer and clinical support is a core part of member services. The company’s official site, cdphp.com, is the primary source for plan details, provider directories, and secure member logins.

When people speak about “CDPHP 24/7 customer service” they usually mean two distinct capabilities: (1) 24/7 clinical advice and urgent-care routing (nurse lines, telehealth/virtual care), and (2) after-hours access to account and claims assistance through secure channels. Understanding which channel handles which issue dramatically shortens resolution time and reduces repeated contacts.

24/7 channels: what is available at any hour

CDPHP’s round-the-clock services are focused on clinical triage and urgent administrative needs. Clinical 24/7 services include a nurse advice line and virtual urgent care, which can assess symptoms, recommend home care, arrange same-day telemedicine visits, or direct members to the nearest emergency department. These services operate irrespective of business hours to help members make safe and timely decisions about symptoms such as chest pain, shortness of breath, severe allergic reactions, or sudden high fevers.

Administrative 24/7 options are usually limited but critical: automated IVR lines, secure messaging through the member portal, and emergency claim escalation routes. For billing disputes, prescription prior authorizations, and detailed benefit questions, daytime phone support is typically required; however, urgent administrative requests—such as verification of emergency authorization or access to an on-call behavioral health clinician—can be handled or routed after hours. For the most reliable contact information, use the number printed on the back of your member ID card or visit cdphp.com/contact for the current departmental listings and hours.

What to prepare before you call or message

Having the right data ready reduces average call time and speeds issue resolution. Before you call CDPHP, gather identifying and situational details so the agent or nurse can act: member ID, date of birth, group number (if employer-sponsored), provider name and NPI if applicable, account-specific claim numbers, and the date(s) of service in question. If the issue concerns a bill, have the provider’s statement and any Explanation of Benefits (EOB) available.

• Essential items to have: front/back photo of member ID, claim or account number, provider office phone, prescription name and NDC (if applicable), and a brief timeline (dates and times) of events or care received.
• For clinical calls: list symptoms, onset time, current medications including doses, allergies, and whether you’ve already used urgent care or emergency services. For appeals or prior authorizations: have applicable medical records or clinical notes on hand.

Common issues, expected timelines, and escalation paths

Typical reasons members call customer service include benefit verification, out-of-network billing questions, claims denials, prior authorization status, prescription coverage and step therapy, and appeals. Standard resolution timelines you can expect: routine claim reviews and benefit clarifications often take 7–14 business days; prior authorization determinations are commonly returned within 3–10 business days depending on service complexity; internal appeal decisions generally follow federal and New York state rules—often 30 calendar days for standard appeals and 72 hours for expedited (urgent) requests.

If an issue is not resolved on first contact, ask the representative for a written confirmation number or secure portal message reference, and request the name/ID of the agent handling the case. For appeals and grievances, note statutory timelines: providers and members will often see written decisions; if you need faster escalation, request to speak with a supervisor, and, if necessary, file an external review with the New York State Department of Financial Services or the federal review body for Medicare Advantage cases.

Costs, coverage verification, and avoiding surprise bills

Costs—premiums, copayments, coinsurance, and deductibles—vary by plan type (HMO, PPO, Medicare Advantage). The most reliable way to confirm patient responsibility is to verify benefits prior to non-emergent care: use the member portal or call the number on the ID card and request an “eligibility and benefits” check for the specific CPT/HCPCS codes. For scheduled procedures, providers should request prior authorization when required; failure to obtain an authorization can lead to claim denials and significant patient liability.

To guard against surprise bills, always confirm whether the provider and facility are in-network and ask if ancillary services (anesthesiology, radiology, pathology) are contracted. If you receive an unexpected out-of-network bill after an emergency, document the date/time/location and contact customer service promptly; many cases are resolved within 30 days once documentation is submitted.

Practical step-by-step script and tips

When you contact CDPHP, lead with purpose to shorten the call: “Hello, I’m [Name], member ID [######], and I need a benefit verification for [CPT code/date of service] or an update on prior authorization # [if available].” If calling about a claim, state the claim number and provider name up front. If you need a clinical decision urgently (e.g., hospital admission authorization or prescription override), say “This is time-sensitive/urgent” and request expedited/clinical triage.

Finally, follow up in writing. Use the secure member portal to log the interaction, attach any supporting documents, and keep copies of all EOBs and correspondence. If resolution stalls, escalate to a supervisor, file a formal grievance through the portal or by mail, and—if applicable—pursue external review channels. For contact details and the latest departmental hours, always check cdphp.com/contact and the back of your member ID card before calling.

Is CDPHP an HMO?

CDPHP® Core (HMO) is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company.

What is the phone number for CDPHP long term care?

Section 7.1 – Getting Help from CDPHP® Focus (PPO)
We’re here to help. Please call Member Services at (518) 641-3950 or 1-888-248- 6522.

Is CDPHP being sold?

Here’s the scoop (from someone with insider knowledge)—CDPHP is in the process of being acquired by the Lifetime Companies, which also owns two other insurance companies— Excellus and Univera.

What is the rating of CDPHP?

Capital District Physicians’ Healthcare Network Commercial (HMO/POS) – 4.5 out of 5. CDPHP Universal Benefits, Inc. – Commercial (PPO) – 4.5 out of 5.

Is CDPHP being sued?

The Albany Med Health System is suing health insurer CDPHP. The hospital says Capital Region Physicians Health Plan is withholding $27 million in payments for care it provided to CDPHP customers, which could escalate to $50 million by year-end.

What is the CDPHP controversy?

In late 2024, Albany Medical Center sued CDPHP for withholding millions in payments related to the wage index. An agreement was reached, and the hospital dropped the charges. Dr. Lance Sullenberger, a cardiologist and chief operating officer at Capital Cardiology Associates, emphasized the importance of these payments.