HMO Complaints for Calendar Year 2005
(January - December)
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| Basic Service HMOs |
Total Number of Complaints (Closed Cases) |
Justified Complaints |
Enrollment (Sep 2005) |
Ratio of Justified Complaints per 10,000 enrollees* |
| AETNA HEALTH INC. |
816 |
259 |
295,702 |
8.76 |
| AETNA HEALTH OF NORTH TEXAS INC. |
1 |
0 |
0 |
0.00 |
| AMCARE HEALTH PLANS OF TEXAS, INC. |
6 |
1 |
0 |
0.00 |
| AMERIGROUP TEXAS, INC. |
74 |
6 |
405,261 |
0.15 |
| AMIL INTERNATIONAL (TEXAS), INC. |
259 |
157 |
0 |
0.00 |
| CIGNA HEALTHCARE OF TEXAS, INC. |
158 |
73 |
65,433 |
11.16 |
| COMMUNITY FIRST HEALTH PLANS, INC. |
15 |
3 |
75,424 |
0.40 |
| COMMUNITY HEALTH CHOICE, INC. |
6 |
0 |
50,280 |
0.00 |
| COOK CHILDREN'S HEALTH PLAN |
1 |
0 |
28,191 |
0.00 |
| DRISCOLL CHILDREN'S HEALTH PLAN |
2 |
0 |
10,770 |
0.00 |
| EL PASO FIRST HEALTH PLAN, INC. |
10 |
5 |
44,533 |
1.12 |
| EVERCARE OF TEXAS, L.L.C. |
17 |
0 |
35,505 |
0.00 |
| GREAT WEST HEALTHCARE |
18 |
11 |
9,086 |
1.21 |
| HEALTH CARE SERVICE CORP. (BC/BS) |
372 |
115 |
252,714 |
4.55 |
| HEALTHSPRING, INC. |
15 |
0 |
0 |
0.00 |
| HUMANA HEALTH PLAN OF TEXAS, INC. |
224 |
70 |
94,667 |
7.39 |
| LEGACY HEALTH SOLUTIONS |
0 |
0 |
540 |
0.00 |
| MERCY HEALTH PLANS OF MISSOURI, INC. |
6 |
2 |
11,924 |
1.68 |
| METROWEST HEALTH PLAN, INC. |
2 |
0 |
0 |
0.00 |
| PACIFICARE OF TEXAS, INC. |
101 |
5 |
127,628 |
0.39 |
| PARKLAND COMMUNITY HEALTH PLAN, INC. |
5 |
1 |
108,845 |
0.09 |
| PSO HEALTH SERVICE |
2 |
0 |
281 |
0.00 |
| SCOTT & WHITE HEALTH PLAN |
95 |
9 |
166,852 |
0.54 |
| SELECTCARE OF TEXAS, L.L.C. |
19 |
1 |
23,270 |
0.43 |
| SETON HEALTH PLAN, INC. |
6 |
0 |
16,808 |
0.00 |
| SHA, L.L.C. |
57 |
12 |
85,550 |
1.40 |
| SOUTHWEST TEXAS HMO, INC. |
52 |
21 |
0 |
0.00 |
| SUPERIOR HEALTHPLAN, INC. |
36 |
23 |
162,020 |
1.42 |
| TEXAS CHILDREN'S HEALTH PLAN, INC. |
9 |
2 |
132,445 |
0.15 |
| TEXAS HEALTH CHOICE, L.C. |
2 |
0 |
0 |
0.00 |
| TEXAS HEALTHSPRING I, LLC |
2 |
0 |
28,421 |
0.00 |
| TEXAS UNIVERSITIES HEALTH PLAN, INC. |
2 |
0 |
0 |
0.00 |
| UNICARE HEALTH PLANS OF TEXAS, INC. |
97 |
36 |
20,235 |
17.79 |
| UNITED HEALTHCARE OF TEXAS, INC. |
193 |
60 |
36,703 |
16.35 |
| UTMB HEALTH PLANS, INC. |
13 |
3 |
26,473 |
1.13 |
| VALLEY BAPTIST HEALTH PLAN, INC. |
5 |
1 |
12,585 |
0.08 |
| AVERAGE: |
|
|
|
2.12 |
| Single & Limited Service HMOs |
Total Number of Complaints (Closed Cases) |
Justified Complaints |
Enrollment (Sep 2005) |
Ratio of Justified Complaints per 10,000 enrollees* |
| AECC TOTAL VISION HEALTH PLAN OF TEXAS |
0 |
0 |
716,664 |
0.00 |
| AETNA DENTAL, INC. |
7 |
2 |
576,798 |
0.03 |
| ALPHA DENTAL PROGRAMS, INC. |
2 |
1 |
37,817 |
0.26 |
| BLOCK VISION OF TEXAS, INC. |
0 |
0 |
582,435 |
0.00 |
| CIGNA DENTAL HEALTH OF TEXAS, INC. |
8 |
0 |
260,473 |
0.00 |
| DENTICARE, INC. |
1 |
0 |
116,767 |
0.00 |
| MANAGED DENTAL GUARD, INC. |
4 |
1 |
50,578 |
0.02 |
| MNM-1997, INC. |
0 |
0 |
40,921 |
0.00 |
| NATIONAL PACIFIC DENTAL, INC. |
5 |
1 |
172,901 |
0.06 |
| PEARLE VISION MANAGED CARE |
0 |
0 |
309,284 |
0.00 |
| SAFEGUARD HEALTH PLANS, INC. |
12 |
4 |
112,446 |
0.36 |
| UNITED CONCORDIA DENTAL PLANS OF TEXAS |
5 |
1 |
4,188 |
0.24 |
| UNITED DENTAL CARE OF TEXAS, INC. |
4 |
1 |
170,389 |
0.06 |
| VALUEOPTIONS OF TEXAS, INC. |
3 |
0 |
267,103 |
0.00 |
| |
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| AVERAGE: |
2749 |
887 |
|
0.07 |
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| * calculations differ if less than 10,000 enrollees |
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| count includes record only and CHIP |
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For more information contact: Hmogrp@tdi.state.tx.us
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Texas Department of Insurance
