CDPHP Customer Service Number — How to find, use, and escalate

Where to find the correct CDPHP customer service number

CDPHP uses different phone numbers for different lines (member services, Medicare, provider relations, pharmacy prior authorization, claims, grievances). The single most reliable place to find the exact customer service number for your plan is your member ID card and the official website: cdphp.com. Your ID card lists the number that routes calls directly to your specific product (employer group, individual, Medicare Advantage, Medicaid/CHP), and the website has a contact menu that maps numbers to enrollment types and hours.

If you do not have your ID card handy, go to cdphp.com and open “Contact Us” or “Member Services.” For accessibility, keep in mind standard relay conventions: if you need TTY service, use 711. For any immediate life‑threatening condition, dial 911 — CDPHP customer service cannot replace emergency care.

Typical CDPHP contact channels and what each handles

CDPHP supports multiple channels so a single phone number is not always the fastest route. Typical channels include: member phone lines (plan-specific), secure member portal messages, live chat on the website, a mobile app with digital ID cards, pharmacy help desks (for prior authorization and formulary questions), and provider services for credentialing, referrals, and electronic claims submission. Use the portal or app for secure document uploads and non-urgent messages — these are trackable and usually resolved without a phone hold.

When you need to call, expect these department distinctions: Member Services handles eligibility, ID cards, benefits summaries and premium billing; Claims and Appeals handles payment decisions and appeals (standard decisions often within 30 calendar days, urgent/expedited appeals faster — commonly within 72 hours); Pharmacy Support and Utilization Management handles prior authorizations and step-therapy. Provider Services will ask for NPI, Tax ID, and claim numbers when discussing claims or contracts.

Key practical phone-call details and typical timelines

Before you dial, prepare: your member ID number, date of birth, the specific claim or authorization number if available, provider NPI and office phone, dates of service, and any bills or Explanation of Benefits (EOB) pages. Average live‑agent hold times vary by time of year (open enrollment and January commonly see longer waits) — typical waits are 2–15 minutes; if your call is routed to specialty departments, expect callbacks within 24–72 hours. Ask the agent for a reference number for the call and the agent’s name for follow‑up.

Regulatory timelines to remember: insurers commonly resolve standard claims appeals within about 30 calendar days; urgent/expedited appeals are usually addressed within 72 hours. Pharmacy prior authorization requests may be resolved within 24–72 hours, or sooner if urgent. Always request the target date for resolution when you call and confirm whether the decision will be communicated by phone, secure message, or mailed letter.

Department checklist — what phone lines or information you’ll likely need

• Member Services: plan eligibility, ID cards, premiums, address changes (check your ID card first; if you don’t have it use cdphp.com/member).
• Claims & Appeals: use the claim number from the EOB; request appeal forms and obtain a written denial if you plan to appeal to an external review body.
• Pharmacy Support: for Rx issues have your BIN, PCN, Rx group, Rx number and the prescribing physician’s NPI; typical copays range by tier (examples: $0–$10 for generics, $30–$100 for specialty drugs depending on the plan).
• Provider Services: credentialing, contract and claims submission — have your NPI, Tax ID and electronic payer IDs available.

How to escalate a call and external complaint options

If the frontline agent cannot resolve your issue, ask to speak to a supervisor and get a callback time. Document the name of each person you speak with, the date and time, and a concise summary of what was discussed. If you receive a written denial and believe it is incorrect, file a formal internal appeal with CDPHP; request the appeal timeline in writing and include supporting medical records or letters of medical necessity.

If internal appeals are exhausted or you suspect a regulatory violation, you can escalate to New York State agencies (for example, the Department of Financial Services or the Department of Health) or to federal bodies for Medicare plans. CDPHP’s online “Grievance & Appeal” pages and your plan’s Evidence of Coverage (EOC) list the exact steps and external review contacts — save copies of everything you submit and note the dates you mailed or uploaded documents.

Practical tips to make phone contact efficient

Keep digital copies (scans or photos) of bills, EOBs, authorization letters, and the front/back of your ID card in your member portal so you can reference them quickly during calls. Use the secure messaging function for documentation-heavy issues; written messages create an auditable trail. If the issue is time‑sensitive (scheduled surgery, urgent prior authorization), request expedited review and ask for the escalation number that triggers a faster response.

Finally, bookmark cdphp.com and the specific contact page for your plan; if you’re a provider, register for electronic remittance (ERA) and clearinghouse access to speed claims reconciliation. Well‑prepared calls resolve most problems within a single phone session; when they don’t, the documentation you create during the call is the most powerful tool for rapid escalation.

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 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.

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.

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 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.

What is the member number on the CDPHP card?

This information can be found on your CDPHP ID card. STEP 3 Enter your full name as it appears on your CDPHP ID card, date of birth, and member ID. Your member ID is located on your ID card. Your member ID is nine characters, plus the two-digit number in front of your name.