HMO Complaints for Calendar Year 2004
| Basic Service HMOs | Total Number of Complaints (Closed Cases) | Justified Complaints | Enrollment (Jun 2004) | Ratio of Justified Complaints per 10,000 enrollees* |
|---|---|---|---|---|
| AETNA HEALTH INC. | 1037 | 428 | 340,374 | 12.57 |
| AETNA HEALTH OF NORTH TEXAS INC. | 20 | 8 | 0 | 0.00 |
| AMCARE HEALTH PLANS OF TEXAS, INC. | 13 | 0 | 0 | 0.00 |
| AMERIGROUP TEXAS, INC. | 106 | 26 | 356,465 | 0.73 |
| AMIL INTERNATIONAL (TEXAS), INC. | 71 | 30 | 23,462 | 12.79 |
| CIGNA HEALTHCARE OF TEXAS, INC. | 342 | 181 | 75,174 | 24.08 |
| COMMUNITY FIRST HEALTH PLANS, INC. | 18 | 2 | 75,451 | 0.27 |
| COMMUNITY HEALTH CHOICE, INC. | 14 | 1 | 47,127 | 0.21 |
| COOK CHILDREN'S HEALTH PLAN | 2 | 1 | 29,645 | 0.34 |
| DRISCOLL CHILDREN'S HEALTH PLAN | 7 | 5 | 12,856 | 3.89 |
| EL PASO FIRST HEALTH PLAN, INC. | 8 | 3 | 39,735 | 0.76 |
| EVERCARE OF TEXAS, L.L.C. | 10 | 0 | 33,141 | 0.00 |
| GREAT WEST HEALTHCARE | 11 | 4 | 12,781 | 3.13 |
| HEALTH CARE SERVICE CORP. (BC/BS) | 166 | 39 | 241,172 | 1.62 |
| HEALTHPLAN OF TEXAS, INC. | 1 | 0 | 0 | 0.00 |
| HEALTHSPRING, INC. | 8 | 1 | 0 | 0.00 |
| HUMANA HEALTH PLAN OF TEXAS, INC. | 244 | 107 | 199,170 | 5.37 |
| MERCY HEALTH PLANS OF MISSOURI, INC. | 1 | 1 | 13,026 | 0.77 |
| METROWEST HEALTH PLAN, INC. | 9 | 1 | 13,208 | 0.08 |
| PACIFICARE OF TEXAS, INC. | 117 | 21 | 111,821 | 1.88 |
| PARKLAND COMMUNITY HEALTH PLAN, INC. | 5 | 1 | 106,246 | 0.09 |
| SCOTT & WHITE HEALTH PLAN | 24 | 4 | 166,949 | 0.24 |
| SELECTCARE OF TEXAS, L.L.C. | 12 | 0 | 16,503 | 0.00 |
| SETON HEALTH PLAN, INC. | 13 | 2 | 16,680 | 1.20 |
| SHA, L.L.C. | 95 | 22 | 84,416 | 2.61 |
| SOUTHWEST TEXAS HMO, INC. | 462 | 148 | 0 | 0.00 |
| SUPERIOR HEALTHPLAN, INC. | 9 | 4 | 155,332 | 0.26 |
| TEXAS CHILDREN'S HEALTH PLAN, INC. | 16 | 2 | 120,887 | 0.17 |
| TEXAS HEALTH CHOICE, L.C. | 3 | 1 | 0 | 0.00 |
| TEXAS HEALTHSPRING I, LLC | 0 | 0 | 18,205 | 0.00 |
| TEXAS UNIVERSITIES HEALTH PLAN, INC. | 1 | 0 | 0 | 0.00 |
| UNICARE HEALTH PLANS OF TEXAS, INC. | 43 | 12 | 23,377 | 5.13 |
| UNITED HEALTHCARE OF TEXAS, INC. | 283 | 164 | 48,755 | 33.64 |
| UTMB HEALTH PLANS, INC. | 7 | 1 | 31,830 | 0.31 |
| VALLEY BAPTIST HEALTH PLAN, INC. | 1 | 0 | 9,643 | 0.00 |
| AVERAGE: | 3.20 | |||
| Single & Limited Service HMOs | Total Number of Complaints (Closed Cases) | Justified Complaints | Enrollment (Jun 2004) | Ratio of Justified Complaints per 10,000 enrollees* |
| AECC TOTAL VISION HEALTH PLAN OF TEXAS | 1 | 0 | 604,842 | 0.00 |
| AETNA DENTAL, INC. | 18 | 2 | 588,549 | 0.03 |
| ALPHA DENTAL PROGRAMS, INC. | 4 | 1 | 39,872 | 0.25 |
| BLOCK VISION OF TEXAS, INC. | 0 | 0 | 478,548 | 0.00 |
| CIGNA DENTAL HEALTH OF TEXAS, INC. | 7 | 2 | 281,231 | 0.07 |
| DENTICARE, INC. | 0 | 0 | 119,374 | 0.00 |
| MANAGED DENTAL GUARD, INC. | 2 | 0 | 38,565 | 0.00 |
| MNM-1997, INC. | 0 | 0 | 35,306 | 0.00 |
| NATIONAL PACIFIC DENTAL, INC. | 12 | 4 | 165,348 | 0.24 |
| PEARLE VISION MANAGED CARE | 0 | 0 | 263,696 | 0.00 |
| SAFEGUARD HEALTH PLANS, INC. | 15 | 5 | 103,762 | 0.48 |
| UNITED CONCORDIA DENTAL PLANS OF TEXAS | 203 | 4 | 3,562 | 1.12 |
| UNITED DENTAL CARE OF TEXAS, INC. | 12 | 5 | 189,778 | 0.26 |
| VALUEOPTIONS OF TEXAS, INC. | 2 | 0 | 250,496 | 0.00 |
| AVERAGE: | 3455 | 1243 | 0.18 | |
| * calculations differ if less than 10,000 enrollees |
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Last updated: 11/15/2006
