If an agreement isn’t reached, patients could see increased costs for emergency services at Promedica facilities starting in 2026.
Toledo, Ohio – A potential contract dispute between Promedica and Ohio Medical Care might lead to significant changes for patients next year.
Promedica has informed patients that hospitals, clinics, and physician services may be excluded from the network for all subscribers of the Medical Interchange Product from 2026 if they don’t finalize a new contract.
In a statement provided to WTOL 11, Promedica said:
“The rising costs of healthcare are outpacing rebates from insurance companies, making it crucial for Promedica to negotiate with commercial insurers, like Medical Mutual, which is necessary for Promedica to keep investing in critical resources for delivering advanced care to patients.”
“Sadly, Promedica and Medical Mutual, along with their subsidiary Medical Mutual -Paramount, have yet to agree on a commercial insurance contract for 2026. This concerns the services provided by Promedica Hospital and Promedica Physician Group to their Medical Mutual and Medical Mutual Paramount members.”
Medical Mutual has not provided any public statement regarding these negotiations.
This situation affects all Medical Mutual products, including those through Paramount Health Care, which has been under Medical Mutual’s ownership since May 2024.
Previously owned by Promedica, Paramount Health is now fully controlled by Medical Mutual. Consequently, members of Paramount Insurance might also lose in-network access to Promedica providers unless a new contract is signed.
If a transaction isn’t finalized before these deadlines, patients seeking non-emergency care from Promedica could face out-of-network fees.
What does this mean for the patient?
Changes may impact residents of northwest Ohio who rely on Promedica for healthcare and use Medical Mutual as their insurance provider. The affected facilities include:
- Promedica Toledo Hospital
- Promedica Flower Hospital
- Promedica Bay Park Hospital
- Toledo Children’s Hospital
- Various Promedica emergency care centers and clinics across the region
Services at these locations might not be covered at in-network rates unless they are for emergency situations.
University of Toledo Employee Updates
Officials at the University of Toledo have shared with employees that Promedica will maintain its current Tier 2 status in the Medical Inter-Medicine Plan until the end of 2025. This allows employees to access Promedica’s services at the same benefit level as this year. However, coverage details for 2026 remain unclear.
What patients can do now
Medical Mutual customers are advised to:
- Review your current plan – Contact customer service to discuss how out-of-network billing may impact you.
- Talk to your employer’s HR department – They should provide updates on possible plan changes or guidance for 2026.
- Stay informed – As negotiations proceed, more information will become available.
Neither Promedica nor Medical Mutual has officially commented on the negotiations’ status, and no resolutions have been confirmed as of now.
This story is still unfolding. Updates will be provided as more information comes to light.
