TriHealth-UnitedHealthcare Contract Dispute Raises Patient Cost Concerns

A contract dispute between TriHealth and UnitedHealthcare has created uncertainty for thousands of patients in the Tri-State area, with a December 31 deadline looming to reach an agreement. The ongoing negotiations have raised concerns about potential increased medical costs if no deal is finalized. Patients, including those with UnitedHealthcare Medigap Plan G coverage, face the risk of significant out-of-pocket expenses or losing access to familiar TriHealth providers. TriHealth's medical director has acknowledged the frustrations patients are experiencing, emphasizing the health system's intent to prioritize patient care. The dispute centers on reimbursement rates, with TriHealth seeking parity with payments offered to other peer health systems, while UnitedHealthcare contends the requested 35% rate increase is excessive and could impact local employers' operating budgets. The disagreement specifically affects UnitedHealthcare commercial and Medicare Advantage plans, while supplemental plans such as Medigap Plan G remain unaffected. Pregnant women and patients undergoing ongoing treatment may qualify for special coverage extensions to avoid immediate disruptions. Negotiations have been ongoing for over a year, with TriHealth expressing a commitment to reach a resolution, but UnitedHealthcare has been less communicative recently. The December 31 deadline compounds concerns as Medicare open enrollment closes on December 7, limiting options for patients to adjust their coverage. Industry stakeholders should monitor this dispute as its resolution or escalation could influence payer-provider contract negotiations and impact local healthcare access and costs. Patients are advised to stay informed and proactively manage their health coverage options ahead of the deadline.