CINCINNATI — Time is running out for TriHealth and UnitedHealthcare to reach a deal that would keep thousands of Tri-State patients in-network.
With less than 48 hours until the new year, there's still no agreement between the two companies. I spoke with a TriHealth spokesperson on Dec. 29, and they say they're still hopeful a deal can be reached this week.
Here's everything you need to know about who's impacted and what could change starting Jan. 1.
WATCH: TriHealth vs United Healthcare negotiations
Which plans are affected?
Plans that WILL lose in-network coverage:
- UnitedHealthcare commercial (employer-sponsored)
- Medicare Advantage plans
Plans that are NOT affected:
- Original Medicare (Part A & B)
- UnitedHealthcare Medigap plans (Plan G, N, etc.)
What we know about the negotiations
The two sides remain at odds over payment rates and claim denials:
TriHealth's position:
- Wants fair reimbursement that covers the actual cost of care to maintain their population health model
- Seeks to reduce administrative red tape so medical staff spend more time on patient care instead of paperwork
- Claims UnitedHealthcare "has not been a good partner" and wants reimbursement that reflects patient outcomes
- Says they've made "significant compromises," but UnitedHealthcare indicates it's not enough
UnitedHealthcare's position:
- Says TriHealth is demanding significant price hikes that would burden local employers
- Claims approximately 90% of Cincinnati employers self-fund their health plans, meaning rate increases directly impact businesses
- Argues TriHealth's proposal would increase healthcare costs for families during challenging times
- States they're proposing market-competitive rates and will continue negotiating
What happens if TriHealth goes out-of-network?
If no deal is reached by midnight on Dec. 31:
- Higher costs: Patients will pay significantly more for TriHealth services
- Limited coverage: Out-of-network benefits typically cover less
- Potential disruption: Ongoing treatments may be affected
- Provider changes: Some patients may need to switch doctors or hospitals
"My gut feels sick. It makes me feel afraid being one of the people who's living on a fixed income right now," one patient, Deborah Kovacs-Sturdevant, told us.
Kovacs-Sturdevant said she felt like other UnitedHealthcare subscribers were being "used as pawns" in the fight.
Actions you can take right now
For patients in active treatment:
- Apply for continuity of care by calling the number on the back of your insurance card
- Women who are pregnant may qualify
- Patients with newly diagnosed, relapsed or active cancer treatment may qualify
- United Healthcare says it has approved all continuity of care requests received to date
- Ask about out-of-network benefits if no agreement is reached
For all affected patients:
- Call the number on your health plan ID card for assistance finding alternative in-network providers
- Review your insurance plan's out-of-network coverage details
- Keep documentation of all communications with your insurance company
- Contact TriHealth's patient support team at 513-853-2100 with questions
UnitedHealthcare notes they have "a broad network of physicians and hospitals throughout the region that are readily able to provide high-quality care" if TriHealth leaves their network.
The dispute could create broader disruptions in the local health care market, as patients may seek alternative coverage options if the impasse continues.
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