TriHealth

We are actively negotiating with TriHealth in Cincinnati, Ohio

Our top priority is to reach an agreement that is affordable for consumers and employers while maintaining continued network access to the health system

Our current contract with TriHealth remains in effect through Dec. 31, 2025 for people enrolled in our commercial, Medicare Advantage and Medicaid plans. 

In the event we are unable to reach an agreement, TriHealth’s hospitals, facilities and physicians would be out of network for the following benefit plans, effective Jan. 1, 2026:

  • UnitedHealthcare employer sponsored commercial plans, including UMR and Surest
  • UnitedHealthcare Medicare Advantage plans, including Group Retiree and Dual Special Needs Plans (DSNP)
  • UnitedHealthcare Medicaid plan of Ohio

We continue to compromise and are proposing rate increases that would reimburse TriHealth at market-competitive rates while balancing the affordability needs of consumers and employers

We are also proposing performance-based incentives that improve the quality of care and help lower costs for the people we collectively serve.

Facts you should know

TriHealth is seeking an approximate 45% price hike for our commercial plans that would increase health care costs by $121 million for consumers and employers

TriHealth’s proposal is not affordable and would significantly drive up premiums and out-of-pocket costs for the people we serve as well as the cost of doing business for employers.

Agreeing to TriHealth’s rate increases would make them the highest cost health system in our network in the greater Cincinnati area

Families and businesses across Southwest Ohio are feeling the growing financial strain of rising health care costs, making it harder for people to access the care they need.

Hospital prices are one of the leading drivers in rising health care costs. Proposals from health systems like TriHealth that include exorbitant price hike demands only exacerbate the unsustainable escalation of health care costs and it is not affordable for consumers or employers.

We remain committed to reaching an agreement with TriHealth that protects affordability and provides continued access to quality care. Our goal is to utilize the remaining months on our contract to renew our relationship.

Approximately $103 million—or 85%—of TriHealth’s proposed price hikes for our commercial plans would be paid out of the operating budgets of self-insured employers

TriHealth’s rate demands would directly drive up health care costs for our self-insured customers given that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims. More than 80% of our commercial members in the greater Cincinnati area are enrolled in self-insured plans.

When working with self-funded customers, we treat their money as if it were our own. These employers have charged us with the responsibility of providing their employees access to quality, affordable health care.

Agreeing to TriHealth’s 45% price hike demands would mean nine employers would see their health care costs increase by $500,000 or more each. One business would experience a $3.8 million increase while another company’s costs would rise by approximately $3.5 million.

As the prices for health care continue to rise, employers have less money available to help grow their business through things like investments in new technologies or increase salaries for employees.

TriHealth’s proposal would significantly impact what consumers pay for services received at its hospitals

To help illustrate the impact of the health system’s 45% price hike demands, consider the following examples, which show how much more these services would increase in costs compared to today:

  • The cost of inpatient surgery would increase by over $5,500 on average;
  • The cost of knee surgery would increase by $15,000 on average;
  • The average cost of hip replacement surgery would increase by nearly $8,300;
  • A colonoscopy would cost approximately $1,100 more than it does today;
  • Delivering a baby via a C-section would increase by over $4,000;
  • The average cost of an emergency room visit would increase by more than $1,200
  • Common imaging services such as MRIs and ultrasounds would go up by approximately $400

In the event TriHealth leaves our network

In the event TriHealth leaves our network, people enrolled in our Group Retiree PPO plans may still receive care from a TriHealth physician as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Their share of the cost will be the same as if they were part of the network.

UnitedHealthcare Group Retiree members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.

For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.

We know the care TriHealth provides to our members is not only important but also personal

We also understand how disruptive it can be for our members and their families when a physician no longer participates in our network. We are fortunate to have a broad network of physicians and hospitals throughout the region that are readily able to provide high-quality care that meets the needs of our members should TriHealth leave our network.

If one of our members is in the middle of treatment for a serious or complex condition with a TriHealth physician or at a TriHealth hospital and they go out of network, they may qualify for continuity of care. Continuity of care provides continued in-network benefits for a specified period of time after a hospital or physician leaves our network.

A few examples of patients who may qualify include:

  • Women who are pregnant;
  • Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment.

Members who have questions about continuity of care or alternative hospitals and physicians in their area should call the number on their health plan ID card. Members can also use the provider directory on our member website to search for alternative hospitals and doctors.

Our track record of renewing contracts with providers is strong

We negotiate thousands of provider contracts every year, and the vast majority of those negotiations result in renewed contracts with no disruption for our members, and also no external noise as the negotiations are handled professionally and behind closed doors.

We are fully committed to engaging in productive, good-faith negotiation and remain focused on our goal of renewing our contract with TriHealth to allow people continued access to quality, affordable care.

We hope TriHealth shares our commitment of reaching an agreement that is affordable for the people and employers we serve.