HMO Complaints for Calendar Year 2003
(January - December 2003)
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| Basic Service HMOs |
Total Number of Complaints (Closed Cases) |
Justified Complaints |
Enrollment (Jun. 2003) |
Ratio of Justified Complaints per 10,000 enrollees* |
| AETNA HEALTH INC. |
839 |
270 |
338,432 |
7.98 |
| AETNA HEALTH OF NORTH TEXAS INC. |
323 |
107 |
0 |
0 |
| AMCARE HEALTH PLANS OF TEXAS, INC. |
337 |
63 |
0 |
0 |
| AMERIGROUP TEXAS, INC. |
76 |
21 |
320,296 |
0.66 |
| AMIL INTERNATIONAL (TEXAS), INC. |
94 |
36 |
23,091 |
15.59 |
| CIGNA HEALTHCARE OF TEXAS, INC. |
701 |
312 |
175,542 |
17.77 |
| COMMUNITY FIRST HEALTH PLANS, INC. |
39 |
18 |
100,433 |
1.79 |
| COMMUNITY HEALTH CHOICE, INC. |
5 |
0 |
41,260 |
0.00 |
| COOK CHILDREN'S HEALTH PLAN |
1 |
1 |
41,686 |
0.24 |
| DRISCOLL CHILDREN'S HEALTH PLAN |
2 |
1 |
19,312 |
0.52 |
| EL PASO FIRST HEALTH PLAN, INC. |
4 |
0 |
36,738 |
0.00 |
| EVERCARE OF TEXAS, L.L.C. |
6 |
0 |
30,240 |
0.00 |
| GREAT-WEST HEALTHCARE OF TEXAS, INC. |
46 |
23 |
17,501 |
13.14 |
| HEALTHPLAN OF TEXAS, INC. |
1 |
0 |
2,179 |
0.00 |
| HEALTHSPRING, INC. |
3 |
0 |
0 |
0.00 |
| HUMANA HEALTH PLAN OF TEXAS, INC. |
237 |
102 |
227,539 |
4.48 |
| MERCY HEALTH PLANS OF MISSOURI, INC. |
3 |
1 |
17,208 |
0.58 |
| METROWEST HEALTH PLAN, INC. |
5 |
0 |
8,729 |
0.00 |
| PACIFICARE OF TEXAS, INC. |
348 |
132 |
164,278 |
8.04 |
| PARKLAND COMMUNITY HEALTH PLAN, INC. |
9 |
3 |
113,287 |
0.26 |
| SCOTT & WHITE HEALTH PLAN |
31 |
3 |
166,122 |
0.18 |
| SELECTCARE OF TEXAS, L.L.C. |
6 |
0 |
15,561 |
0.94 |
| SETON HEALTH PLAN, INC. |
32 |
14 |
35,513 |
3.94 |
| SHA, L.L.C. |
117 |
46 |
92,605 |
4.97 |
| SOUTHWEST TEXAS HMO, INC. |
2469 |
926 |
377,578 |
24.52 |
| SUPERIOR HEALTHPLAN, INC. |
12 |
2 |
131,394 |
0.15 |
| TEXAS CHILDREN'S HEALTH PLAN, INC. |
25 |
6 |
117,822 |
0.51 |
| TEXAS HEALTH CHOICE, L.C. |
37 |
4 |
0 |
0.00 |
| TEXAS HEALTHSPRING I, L.L.C. |
2 |
0 |
14,797 |
0.00 |
| TEXAS UNIVERSITIES HEALTH PLAN, INC. |
5 |
3 |
0 |
0.00 |
| UNICARE HEALTH PLANS OF TEXAS, INC. |
64 |
19 |
33,689 |
5.64 |
| UNITED HEALTHCARE OF TEXAS, INC. |
730 |
407 |
134,748 |
30.20 |
| UTMB HEALTH PLANS, INC. |
24 |
7 |
46,745 |
1.50 |
| VALLEY BAPTIST HEALTH PLAN, INC. |
3 |
1 |
10,878 |
0.92 |
| WELLCARE HEALTH PLANS OF TEXAS, INC. |
3 |
1 |
0 |
0.00 |
| AVERAGE: |
|
|
| 4.10 |
|
|
|
|
| |
| Single & Limited Service HMOs |
Total Number of Complaints (Closed Cases) |
Justified Complaints |
Enrollment (Jun. 2003) |
Ratio of Justified Complaints per 10,000 enrollees* |
| AECC TOTAL VISION HEALTH PLAN OF TEXAS |
1 |
0 |
793,594 |
0.00 |
| AETNA DENTAL, INC. |
24 |
13 |
596,580 |
0.22 |
| AETNA DENTAL MAINTENANCE ORG. |
2 |
2 |
0 |
0.00 |
| ALPHA DENTAL PROGRAMS, INC. |
2 |
0 |
38,707 |
0.00 |
| BLOCK VISION OF TEXAS, INC. |
0 |
0 |
450,863 |
0.00 |
| CIGNA DENTAL HEALTH OF TEXAS, INC. |
15 |
6 |
317,522 |
0.19 |
| DENTICARE, INC. |
5 |
1 |
121,624 |
0.08 |
| MANAGED DENTAL GUARD, INC. |
1 |
0 |
21,867 |
0.00 |
| MNM-1997, INC. |
0 |
0 |
4,079 |
0.00 |
| NATIONAL PACIFIC DENTAL, INC. |
5 |
1 |
161,333 |
0.06 |
| PEARLE VISION MANAGED CARE |
0 |
0 |
354,649 |
0.00 |
| SAFEGUARD HEALTH PLANS, INC. |
10 |
1 |
99,329 |
0.10 |
| UNITED CONCORDIA DENTAL PLANS OF TEXAS |
9 |
1 |
3,521 |
0.28 |
| UNITED DENTAL CARE OF TEXAS, INC. |
15 |
5 |
212,007 |
0.24 |
| VALUEOPTIONS OF TEXAS, INC. |
9 |
2 |
261,076 |
0.08 |
|
|
|
|
| |
|
|
|
|
| |
| AVERAGE: |
|
|
| 0.08 | * calculations differ if less than 10,000 enrollees counts do not include CHIP complaints
For more information contact: Hmogrp@tdi.state.tx.us
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Texas Department of Insurance
