CINCINNATI — Thousands of Tri-State patients could face significantly higher medical costs if TriHealth and UnitedHealthcare fail to reach a contract agreement by Dec. 31.
The ongoing dispute has left patients feeling anxious and trapped as the deadline approaches. We’ve received a flood of emails this week from patients worried about losing coverage and facing soaring out-of-pocket costs.
“How can this be fair? We’re already overtaxed, and now insurance costs have tripled,” one woman wrote in an email. She initially agreed to speak on camera but later declined, citing fears of repercussions. We brought her and other patients’ concerns directly to both companies to get answers.
WATCH: How to avoid loss of coverage and expensive medical bills
What's at stake for patients
If no deal is reached, patients will have to pay out-of-network costs to continue seeing their TriHealth doctors. This means higher copays, deductibles and potentially thousands more in annual healthcare expenses.
Dr. Raymond Metzger, TriHealth's medical director, acknowledged patient frustrations.
"I think the overall message is don't panic," Metzger said. "First of all, as providers, we want to continue to take care of those patients. I understand the frustration of patients feeling like they're in the middle."
The dispute details
TriHealth and UnitedHealthcare have been negotiating for over a year, with both sides presenting different versions of the conflict.
UnitedHealthcare declined an interview, but provided a statement from a spokesperson:
"TriHealth is demanding a 35% hike that would make it more expensive than any peer health system in the Cincinnati market. Approximately $80 million of the $94 million TriHealth is seeking would come out of the operating budgets of local employers, impacting the money they have to grow their business and compensate their employees. We are proposing rate increases that continue to reimburse TriHealth at market-competitive rates. It remains our top priority to reach an agreement that maintains continued network access to TriHealth. However, we need them to provide a proposal Ohio families and employers can afford."
TriHealth says they want fair compensation.
"We just want fair rates. What they pay Christ, or Mercy, or other systems," Metzger said.
Metzger described the lengthy negotiation process as frustrating for both the health system and patients.
"It's been a long process where we started over a year ago working with United to try to come to terms that are equitable and fair," Metzger said. "We are strongly committed to continuing the negotiations. We're strongly committed to our patients."
"To put it into perspective, I think United's playbook is to delay and create some of this uncertainty, this anxiety, this panic," Metzger said.
What TriHealth wants
According to Metzger, TriHealth is seeking three main things:
- Rate parity with what United pays other local health systems
- Reduced administrative burden from claim denials, delays and payment downgrades
- Recognition of TriHealth as a high-quality, lower-cost provider in the region
What patients can do now
For Medicare Advantage patients:
- Visit TriHealth.com immediately to find other Medicare Advantage plans that keep TriHealth in-network
- Compare benefits to find plans similar to your current coverage
- Switch plans before enrollment deadlines to maintain TriHealth access
- Medicare-eligible patients should speak with a licensed broker during open enrollment to find plans guaranteeing in‑network access in 2026. For updates or help, visit this page or call TriHealth Patient Support at (513) 853‑2100.
For employer insurance patients:
- Call UnitedHealthcare directly and tell them you want to keep your TriHealth doctors
- Contact your HR department to discuss the situation and ask about alternative insurance options
- Document all communications about this issue for your records
Continuity of care coverage:
Patients receiving ongoing treatment can request continuity-of-care coverage.
"Women who may be pregnant right now going through their OB-GYN care, people who will have hospitalizations, you know, things don't magically change on Dec. 31 for our patients," Metzger said. "So, looking at continuity of care arrangements with United, TriHealth's been really working with United. Ultimately, United has the final say in what would be considered in-network after January, but we want our patients to know that we're really making sure that works for them."
- Request continuity-of-care coverage if you're pregnant or receiving ongoing treatment
- Schedule necessary appointments before Dec. 31 while still in-network
- UnitedHealthcare is solely responsible for reviewing and determining eligibility for extended in-network access under Continuity of Care.
- Call the number on the back of your UHC insurance card and ask to speak with someone regarding Continuity of Care.
- Be prepared to provide clinical information and discuss ongoing treatment needs.
- The deadline to initiate a Continuity of Care request is Jan. 30, 2026.
For all patients:
- Review your current benefits to understand in-network vs. out-of-network costs
- Calculate potential expenses if you become out-of-network
- Keep advocating by contacting UnitedHealthcare to express your concerns
This story was reported on-air by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.
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