CINCINNATI — Thousands of Tri-State patients are caught in the middle of a heated contract dispute between TriHealth and UnitedHealthcare that could result in significantly higher medical costs if the companies don't reach an agreement by Dec. 31.
The ongoing negotiations have left patients feeling anxious and uncertain about their healthcare future. WCPO 9 has received numerous emails from worried patients concerned about losing coverage and facing soaring out-of-pocket expenses.
WATCH: What patients need to know about the dispute between TriHealth and UnitedHealthcare
What we've heard from patients
Robin Hendley, a longtime TriHealth patient from Finneytown, exemplifies the frustration many are experiencing. Hendley said she worries the healthcare uncertainty could upend the life she's built.
"When WCPO ran the initial story, immediately I was concerned," Hendley said.
She began calling both TriHealth and UnitedHealthcare to ask whether her UnitedHealthcare Medigap Plan G coverage would be affected.
"That's when I began to get inconsistent answers," Hendley told us.
After several frustrating calls with no clarity, Hendley reached out to WCPO 9 for help.
"I just got very exasperated. And that's when I sent the e-mail to (WCPO 9's John Matarese), and I said, 'Can you help me get some answers?'" she told us.
The timing adds urgency, as Medicare open enrollment closes Dec. 7.
"Open enrollment closes on December 7th. So that's one problem," Hendley said.
For someone deeply rooted in her community, the potential healthcare disruption raises serious concerns.
For Hendley, concerns included wondering if she would need to sell her house.
Still, she told us she wants to maintain her current doctors.
"I certainly don't want to change. I think I've had excellent health care through TriHealth. I like my physicians," Hendley said.
What's at stake
If no deal is reached by Dec. 31, patients will face out-of-network costs to continue seeing their TriHealth doctors. This means:
- Higher copays and deductibles
- Potentially thousands more in annual healthcare expenses
- Loss of established doctor-patient relationships
- Disruption of ongoing treatments
What TriHealth and UnitedHealthcare say
TriHealth's Perspective
Last month, we spoke to Dr. Raymond Metzger, TriHealth's medical director, who acknowledged patient frustrations while defending the health system's position.
"I understand the frustration of patients feeling like they're in the middle," Metzger said. "I think the overall message is don't panic. First of all, as providers, we want to continue to take care of those patients."
Metzger blamed UnitedHealthcare for creating uncertainty through delay tactics.
"I think United's playbook is to delay and create some of this frustration, create some of this anxiety and panic. They're a 400 billion dollar company, we're a medium-sized health system. We want to put patients first," he said.
According to Metzger, TriHealth is seeking:
- Rate parity with what United pays other local health systems
- Reduced administrative burden from claim denials and delays
- Recognition as a high-quality, lower-cost provider
"We just want fair rates. What they pay Christ, or Mercy or other systems," Metzger said.
United Healthcare's Response
United Healthcare did not respond to our request for comment for this story, but provided a statement defending their position in November:
"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."
The company said they are "proposing rate increases that continue to reimburse TriHealth at market-competitive rates" and that reaching an affordable agreement "remains our top priority."
Good news for some patients
TriHealth confirmed that Medigap Plan G and other supplemental plans will not be affected by the negotiations. The dispute only impacts UnitedHealthcare commercial and Medicare Advantage plans.
What patients can do now
For Medicare Advantage Patients:
- Visit TriHealth's website 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
- Speak with a licensed broker during open enrollment
- Call TriHealth Patient Support at (513) 853-2100 for help
For Employer Insurance Patients:
- Call United Healthcare directly and tell them you want to keep your TriHealth doctors
- Contact your human resources department about alternative insurance options
- Document all communications about this issue for your records
Continuity of Care Coverage:
Patients receiving ongoing treatment can request special coverage. This includes:
- Women who are pregnant and receiving OB-GYN care
- Patients scheduled for hospitalizations or ongoing treatments
- Call the number on your UHC insurance card and ask about Continuity of Care
- Be prepared to provide clinical information about ongoing treatment needs
- Important: The deadline to initiate a Continuity of Care request is Jan. 30, 2026
"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.
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
- Schedule necessary appointments before Dec. 31 while still in-network
- Keep advocating by contacting United Healthcare to express your concerns
What's next
The companies have been negotiating for over a year, with the Dec. 31 deadline fast approaching. TriHealth said it remains committed to continuing negotiations, while UnitedHealthcare has not responded to recent requests for comment about the timeline.
Patients are encouraged to stay informed and take proactive steps to protect their healthcare access as the deadline approaches.
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