CINCINNATI — Health Care Costs at Risk for Tri-State Patients

As the deadline of December 31 approaches, many patients in the Tri-State area are facing the possibility of rising health care costs due to ongoing contract negotiations between TriHealth and UnitedHealthcare.

Patients are expressing anxiety about the potential loss of insurance and increasing co-pays, with numerous emails highlighting their worries flooding in this week.

One woman, who initially agreed to share her experience on camera, later opted out due to concerns about possible backlash. In her email, she voiced her frustration: “How can this be fair? We are already overtaxed, and now our premiums have tripled.” We took these concerns to both companies and sought their responses.

What This Means for Patients

Should an agreement not be reached, patients will be faced with out-of-network costs if they wish to continue seeing their TriHealth doctors, leading to higher deductibles and out-of-pocket expenses that could add thousands to their annual medical bills.

Dr. Raymond Metzger, the medical director at TriHealth, recognized the frustrations patients are feeling. “I think the overall message is don’t panic. We want to continue caring for our patients and understand how caught in the middle they feel,” he stated.

Details of the Dispute

The negotiation process between TriHealth and UnitedHealthcare has been ongoing for over a year, with differing accounts of the situation from both parties.

While UnitedHealthcare declined an interview, a spokesperson shared: “TriHealth is seeking a 35% rate increase, which exceeds that of any other health system in the Cincinnati area. The requested $94 million would significantly impact local employers’ ability to manage operating budgets. Our goal is to offer rate increases that keep TriHealth competitively compensated while remaining affordable for Ohio families.”

On the flip side, TriHealth insists they are simply asking for fair compensation, claiming, “We just want a fair rate.” Metzger added that the drawn-out negotiations have caused frustration for everyone involved.

He also suggested that UnitedHealthcare’s strategy might be to create a sense of uncertainty, which could induce anxiety among patients: “It’s been a lengthy process, but we are committed to finding a resolution for our patients.”

What TriHealth Wants

TriHealth is looking for three key objectives:

• Rates that are on par with what United Airlines pays to regional health systems
• A reduction in administrative issues relating to claim denials, delays, and payment reductions
• Recognition as a high-quality, low-cost provider in the region

Actions for Patients

For Medicare Advantage Patients:

• Check TriHealth’s website for alternative Medicare Advantage plans that include in-network access.
• Compare benefits to find options similar to your current plan.
• Switch plans before the enrollment deadline to maintain access to TriHealth.
• Consult a licensed broker during open enrollment for a plan that guarantees in-network access in 2026. For up-to-date information, visit the TriHealth website or call their Patient Support.

For Employment Insurance Patients:

• Contact UnitedHealthcare to advocate for keeping your TriHealth doctor.
• Discuss your situation with your human resources department about possible alternative insurance options.
• Keep a record of all communications related to this matter.

For Continuing Care Coverage:

Patients undergoing ongoing treatment can request to continue their coverage. “Pregnant women currently receiving gynecological care or those who may need hospitalization will not be affected overnight just because it’s December 31,” Metzger explained. “We are working hard with United on a continuity care agreement, but United has the final say post-January.”

• Request continuation of treatment coverage if you are pregnant or undergoing ongoing treatment.
• Schedule your appointments before December 31.
• Reach out to UnitedHealthcare for information on eligibility for continued in-network access.
• Provide clinical information when discussing ongoing treatment needs.
• The deadline for initiating a continuity of care request is January 30, 2026.

General Advice for All Patients:

• Review your benefits and understand both in-network and out-of-network costs.
• Estimate potential expenses if you lose network access.
• Communicate your concerns to UnitedHealthcare and continue advocating for your needs.

This issue has been reported and verified by our editorial team.