HMO Complaints for Calendar Year 1999
| 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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Last updated: 01/05/2009