Ongoing negotiations between TriHealth and UnitedHealthcare could force thousands of Cincinnati residents to change providers or face interruptions in their health insurance coverage, affecting critical procedures and birthing plans.
“As of now, December 31 will be the last day UnitedHealthcare is in network with TriHealth providers and facilities,” said Raymond Metzger, MD, president of TriHealth Population Health Organization.
If no agreement is reached soon, roughly 80,000 patients may need to make significant adjustments to their care.
“A lot of patients, if they are in the middle of an episode of care—whether for heart treatment, cancer, or pregnancy—these things don’t end magically on December 31,” Metzger added.
The two companies have been negotiating a new contract for a year. TriHealth says it is seeking fair reimbursement, reduced administrative burdens, and recognition for delivering high-quality care at lower costs compared with other regional providers.
“So what United would give our other health systems in the region is less than what we’re getting. That’s a big issue. We have collaborative agreements with other providers, and we’re just trying to get up to par,” Metzger explained.
UnitedHealthcare responded, stating, “TriHealth is demanding a 35% increase that would make it more expensive than any peer health system in the Cincinnati market. About $80 million of the $94 million TriHealth is seeking would come from the operating budgets of local employers, affecting their ability to grow their business and pay employees. We are proposing rate increases that keep TriHealth at market-competitive levels.”
Both companies hope to establish a continuity-of-care agreement, allowing patients with critical needs to remain with their current providers if talks extend beyond the end of the year. TriHealth noted that such an agreement would depend on UnitedHealthcare’s cooperation.
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