TriHealth and UnitedHealthcare negotiations could disrupt health insurance
Thousands of people in Cincinnati face potential disruptions in their health insurance or may need to switch providers due to ongoing negotiations between TriHealth and UnitedHealthcare, with critical procedures and birthing plans hanging in the balance.”As of now, December 31st will be the last day that UnitedHealthcare is in network with TriHealth providers and facilities,” Raymond Metzger, MD, president of TriHealth Population Health Organization, said.Unless negotiations change quickly between one of the country’s largest healthcare companies and one of the area’s primary hospital groups, approximately 80,000 patients will need to make significant adjustments. “A lot of patients, if they are in the middle of an episode of care, whether that’s treatment for their heart or for cancer or maybe pregnancy, these things don’t end magically on December 31st,” Metzger said.The two companies have been in talks for a new deal for a year. TriHealth said it approached the negotiations seeking fair reimbursement from UnitedHealthcare, less administrative red tape and more appreciation for their quality of care at a lower cost than other area providers. “So what United would give our other health systems in the region is less than what we’re getting. So, that’s a big thing and we have collaborative agreements with other players. That’s really what we’re looking for, is just to get up to par,” Metzger said.UnitedHealthcare responded with a statement, saying, “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.”Both companies hope to establish a continuity of care deal, allowing patients in critical need to remain with their provider if negotiations extend beyond the end of the year.TriHealth noted that this would depend on the mercy and good faith of UnitedHealthcare.
Thousands of people in Cincinnati face potential disruptions in their health insurance or may need to switch providers due to ongoing negotiations between TriHealth and UnitedHealthcare, with critical procedures and birthing plans hanging in the balance.
“As of now, December 31st will be the last day that UnitedHealthcare is in network with TriHealth providers and facilities,” Raymond Metzger, MD, president of TriHealth Population Health Organization, said.
Unless negotiations change quickly between one of the country’s largest healthcare companies and one of the area’s primary hospital groups, approximately 80,000 patients will need to make significant adjustments.
“A lot of patients, if they are in the middle of an episode of care, whether that’s treatment for their heart or for cancer or maybe pregnancy, these things don’t end magically on December 31st,” Metzger said.
The two companies have been in talks for a new deal for a year. TriHealth said it approached the negotiations seeking fair reimbursement from UnitedHealthcare, less administrative red tape and more appreciation for their quality of care at a lower cost than other area providers.
“So what United would give our other health systems in the region is less than what we’re getting. So, that’s a big thing and we have collaborative agreements with other players. That’s really what we’re looking for, is just to get up to par,” Metzger said.
UnitedHealthcare responded with a statement, saying, “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.”
Both companies hope to establish a continuity of care deal, allowing patients in critical need to remain with their provider if negotiations extend beyond the end of the year.
TriHealth noted that this would depend on the mercy and good faith of UnitedHealthcare.
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