CINCINNATI — Contract Dispute Affects Tri-State Patients

Many patients across the Tri-State area are feeling the impact of a tense contract disagreement between TriHealth and UnitedHealthcare. If these two companies fail to settle their differences by December 31, healthcare costs for patients may rise significantly.

The negotiations have sparked anxiety among patients, who express concerns about losing their insurance or facing higher copays. WCPO 9 frequently receives messages from worried individuals seeking clarity about their healthcare situation.

Patient Feedback

Robin Hendley, a long-time TriHealth patient from Finneytown, reflects the frustrations shared by many. She worries that this uncertainty could disrupt her life. “When I saw the first article from WCPO, I was immediately worried,” Hendley shared.

She reached out to both TriHealth and UnitedHealthcare to figure out how UnitedHealthcare’s Medigap Plan G might be affected. “We were given different answers,” she said, which only added to her frustration. After struggling to get consistent information, she contacted WCPO for assistance, feeling very distressed. “Can you help me get some answers?” she asked in her email.

The situation has become particularly urgent as Medicare open enrollment wraps up on December 7. “That’s one more thing to think about,” Hendley stated.

As someone deeply invested in her community, the thought of losing medical support raises significant worries. Selling her home, for instance, looms as a possibility. Nevertheless, she emphasized that she wishes to stay with her current doctor, stating, “I would never change. I’ve received great medical care through TriHealth. I like my doctors.”

The Core Issues

If an agreement isn’t reached by the deadline, patients will have to bear additional costs for seeing TriHealth physicians, which could include:

• Higher copayments and deductibles
• Increased annual medical expenses
• Loss of established doctor-patient relationships
• Disruption of ongoing treatments

Perspectives: TriHealth vs. UnitedHealthcare

TriHealth’s View

In a conversation last month, TriHealth Medical Director Dr. Raymond Metzger expressed understanding of patient frustrations but maintained the organization’s stance. “I comprehend how patients feel caught in between,” he said. He urged patients not to panic, emphasizing TriHealth’s commitment to continuing patient care.

Metzger accused UnitedHealthcare of prolonging the situation to induce anxiety. “They’re a massive $400 billion enterprise, while we’re a mid-sized health system focused on our patients,” he stated.

Metzger elaborated on what TriHealth is aiming for:

• Rates on par with those offered to other regional healthcare systems
• Less administrative overhead from claim disputes
• Acknowledgment as a provider of quality care at a reasonable cost

“We just want a fair price,” he noted.

UnitedHealthcare’s Response

While UnitedHealthcare did not provide direct comments, they released a statement earlier in November that defended their position. They claim TriHealth is requesting a 35% rate increase, which they argue would be the highest in the Cincinnati market. They indicated that a significant portion of this demand would impact local employers.

UnitedHealthcare asserted its goal is to ensure that payment rates remain competitive in the market.

Positive Aspects for Some Patients

TriHealth confirmed that the ongoing negotiations do not affect Medigap Plan G or other supplemental plans, meaning those plans are still secure. The dispute mainly concerns commercial and Medicare Advantage plans with UnitedHealthcare.

What Patients Can Do

For Medicare Advantage Patients:

• Explore other Advantage plans that keep TriHealth in-network by visiting their website.
• Compare plan benefits to find a suitable alternative.
• Switch plans before the enrollment deadline to maintain access to TriHealth.
• Consult a licensed broker during open registration for guidance.
• Reach out to TriHealth Patient Support at (513) 853-2100 for assistance.

For Employer-Insured Patients:

• Contact UnitedHealthcare to express your desire to retain your TriHealth physician.
• Check with your Human Resources department about alternative insurance options.
• Keep a record of all related correspondence for future reference.

Continuing Care Coverage:

For those undergoing ongoing treatment, special coverage requests can be made for:

• Pregnant women receiving obstetric care
• Patients scheduled for hospitalization or specific treatments
• Contact the number on your UHC card for continuity inquiries.
• Have clinical details ready regarding your treatment needs.
• Note: The deadline for initiating continuity requests is January 30, 2026.

“Right now, women who may be pregnant are receiving gynecological care… but December 31st won’t suddenly change things,” Metzger cautioned.

For All Patients:

• Review your benefits and know your in-network and out-of-network costs.
• Calculate potential costs if network access is lost.
• Make appointments before December 31 to maintain access.
• Contact UnitedHealthcare to voice your concerns.

Looking Ahead

The two companies have been negotiating for over a year, and time is running out. TriHealth is dedicated to continuing discussions, while UnitedHealthcare hasn’t provided updated details on the timeline for a resolution.

Keeping informed and taking proactive steps is crucial for patients to ensure their healthcare access remains intact as the deadline approaches.