Texas Department of Insurance

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HMO Complaints for Calendar Year 1999

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  Basic Service HMOs Total Number of Complaints (Closed Cases) Number of Justified Complaints Enrollment (September 1999) Ratio of Justified Complaints Per 10,000 Enrollees
1 Aetna U.S. Healthcare of North Texas, Inc. 166 78 121,557 6.42
2 Aetna U.S. Healthcare, Inc. 129 61 155,681 3.92
3 Amcare Health Plans of Texas, Inc. 22 15 8,234 18.22
4 Americaid Texas, Inc. 10 2 67,800 0.29
5 Amerihealth HMO of Texas, Inc. 40 27 0 NA
6 Amerihealth of Texas, Inc. 15 9 51,379 1.75
7 Amil International (Texas), Inc. 12 3 12,458 2.41
8 Cigna Healthcare of Texas, Inc. 232 86 563,468 1.53
9 Community First Health Plans, Inc. 6 4 32,761 1.22
10 Community Health Choice, Inc. 73 41 19,438 21.09
11 Comprehensive Health Services of Texas, Inc. 509 503 0 NA
12 Exclusive Healthcare, Inc. 10 4 0 NA
13 Harris Methodist Texas Health Plan, Inc. 283 121 312,676 3.87
14 Healthfirst HMO, Inc. 16 1 17,078 0.59
15 Healthsource North Texas, Inc. 7 4 0 NA
16 Humana Health Plan of Texas, Inc. 552 317 277,162 11.44
17 Kaiser Foundation Health Plan of Texas 38 22 0 NA
18 Memorial Sisters of Charity HMO, L.L.C. 85 54 94,123 5.74
19 Mercy Health Plans of Missouri, Inc. 2 1 7,459 1.34
20 Methodist Care, Inc. 22 12 55,609 2.16
21 Metrowest Health Plan, Inc. 1 1 1,390 7.19
22 Nylcare Health Plans of the Gulf Coast, Inc. 704 343 406,056 8.45
23 Nylcare Health Plans of the Southwest, Inc. 445 240 206,906 11.60
24 One Health Plan of Texas, Inc. 84 35 34,592 10.12
25 Pacificare of Texas, Inc. 725 415 181,044 22.92
26 PCA Health Plans of Texas, Inc. 369 261 94,703 27.56
27 Presbyterian Health Plan, Inc. 6 3 14,003 2.14
28 Prudential Health Care Plan, Inc. 550 314 540,751 5.81
29 Rio Grande HMO, Inc. 153 89 159,784 5.57
30 Scott and White Health Plan 20 3 150,354 0.20
31 Seton Health Plan, Inc. 4 3 8,380 3.58
32 SHA, L.L.C. 65 26 98,799 2.63
33 Texas Health Choice, L.C. 233 170 120,043 14.16
34 Unicare of Texas Health Plans, Inc. 4 1 0 NA
35 United Healthcare of Texas, Inc. 436 223 296,861 7.51
36 Universal Healthplan, Inc. 1 1 264 37.88
37 Wellcare Health Plans of Texas, L.L.C. 500 478 6,436 742.70
38 West Texas Health Plans, L.C. 6 4 17,941 2.23
  Average for Basic Service HMOs       26.16

 

  Single & Limited Service HMOs Total Number of Complaints (Closed Cases) Number of Justified Complaints Enrollment (September 1999) Justified Complaints Per 10,000 Enrollees
39 AECC Total Vision Health Plan of Texas, Inc. 2 1 407,935 0.02
40 Aetna U.S. Healthcare Dental Plan, Inc. 2 1 31,899 0.31
41 Alpha Dental Programs, Inc. 3 3 50,143 0.60
42 Cigna Dental Health of Texas, Inc. 10 6 296,977 0.20
43 Denticare, Inc. 3 2 133,992 0.15
44 ECCA Managed Vision Care, Inc. 1 1 273,303 0.04
45 Magellan Behavioral Health of Texas, Inc. 3 1 592,592 0.02
46 MNM-1997, Inc. 1 1 2,883 3.47
47 Nylcare Dental Plans of the Southwest, Inc. 6 2 36,749 0.54
48 Parliament Dental Plans, Inc. 2 1 16,079 0.62
49 Pearle Vision Managed Care - HMO of Texas, Inc. 3 3 217,850 0.14
50 Prudential Dental Maintenance Org., Inc. 38 17 536,649 0.32
51 Safeguard Health Plans, Inc. 15 8 224,946 0.36
52 Spectera Dental, Inc. 3 2 167,974 0.12
53 United Concordia Dental Plans of Texas, Inc. 1 1 0 NA
54 United Dental Care of Texas, Inc. 20 8 236,885 0.34
55 Value Behavioral Health of Texas, Inc. 2 1 5,500 1.82
  Average for Single & Limited Service HMOS       0.53
  Total for all HMOs 6,650 4,034    
      61%    

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