HMO Complaints Summary for Calendar Year 2000
| Basic Service HMOs | Total Number of Complaints (Closed Cases) | Justified Complaints | Enrollment (Sept. 2000) | Ratio of Justified Complaints per 10,000 enrollees |
|---|---|---|---|---|
| AETNA U.S. HEALTHCARE INC. | 189 | 94 | 252,766 | 3.72 |
| AETNA U.S. HEALTHCARE OF NORTH TEXAS INC. | 376 | 268 | 238,645 | 11.23 |
| AMCARE HEALTH PLANS OF TEXAS, INC. | 78 | 47 | 7,036 | 66.80 |
| AMERIHEALTH HMO OF TEXAS, INC. | 3 | 3 | 0 | N/A |
| AMIL INTERNATIONAL (TEXAS), INC. | 20 | 11 | 15,109 | 7.28 |
| CIGNA HEALTHCARE OF TEXAS, INC. | 256 | 113 | 120,067 | 9.41 |
| COMMUNITY FIRST HEALTH PLANS, INC. | 10 | 6 | 45,659 | 1.31 |
| COMMUNITY HEALTH CHOICE, INC. | 30 | 21 | 19,438 | 10.80 |
| COMPREHENSIVE HEALTH SERVICES OF TEXAS, INC. | 3 | 2 | 0 | N/A |
| EXCLUSIVE HEALTHCARE, INC. | 4 | 2 | 0 | N/A |
| HARRIS METHODIST TEXAS HEALTH PLAN, INC. | 343 | 254 | 0 | N/A |
| HEALTHFIRST HMO, INC. | 6 | 1 | 1,853 | 5.40 |
| HEALTHPLAN OF TEXAS, INC. | 6 | 2 | 12,280 | 1.63 |
| HEALTHSOURCE NORTH TEXAS, INC. | 4 | 4 | 0 | N/A |
| HUMANA HEALTH PLAN OF TEXAS, INC. | 463 | 238 | 270,207 | 8.81 |
| KAISER FOUNDATION HEALTH PLAN OF TEXAS | 1 | 1 | 0 | N/A |
| MEMORIAL SISTERS OF CHARITY HMO, L.L.C. | 68 | 42 | 67,513 | 6.22 |
| METHODIST CARE, INC. | 65 | 41 | 88,465 | 4.63 |
| MID-CON HEALTH PLANS, L.C. | 5 | 3 | 0 | N/A |
| ONE HEALTH PLAN OF TEXAS, INC. | 58 | 46 | 50,583 | 9.09 |
| PACIFICARE OF TEXAS, INC. | 339 | 273 | 444,444 | 6.14 |
| PARKLAND COMMUNITY HEALTH PLAN, INC., A PROGRAM OF | 2 | 1 | 42,523 | 0.24 |
| PCA HEALTH PLANS OF TEXAS, INC. | 75 | 47 | 0 | N/A |
| PHYSICIANS CARE HMO, INC. | 1 | 1 | 141 | 70.92 |
| PRESBYTERIAN HEALTH PLAN, INC. | 10 | 7 | 11,928 | 5.87 |
| PRUDENTIAL HEALTH CARE PLAN, INC. | 458 | 262 | 349,855 | 7.49 |
| RIO GRANDE HMO, INC. | 273 | 119 | 167,552 | 7.10 |
| SCOTT AND WHITE HEALTH PLAN | 13 | 5 | 152,457 | 0.33 |
| SETON HEALTH PLAN, INC. | 11 | 7 | 22,124 | 3.16 |
| SHA, L.L.C. | 79 | 37 | 78,199 | 4.73 |
| SOUTHWEST TEXAS HMO, INC. | 429 | 235 | 187,531 | 12.53 |
| TEXAS GULF COAST HMO, INC. | 631 | 414 | 415,769 | 9.96 |
| TEXAS HEALTH CHOICE, L.C. | 611 | 452 | 113,744 | 39.74 |
| TEXAS UNIVERSITIES HEALTH PLAN, INC. | 15 | 2 | 5,914 | 3.38 |
| UNITED HEALTHCARE OF TEXAS, INC. | 508 | 294 | 335,146 | 8.77 |
| UTMB HEALTH PLANS, INC. | 2 | 2 | 62,035 | 0.32 |
| WELLCARE HEALTH PLANS OF TEXAS, L.L.C. | 185 | 176 | 1,519 | 1158.66 |
| WEST TEXAS HEALTH PLANS, L.C. | 7 | 2 | 16,813 | 1.19 |
| Average for Basic Service HMOs | 39.60 |
| Single & Limited Service HMOs | Total Number of Complaints (Closed Cases) | Justified Complaints | Enrollment (Sept. 2000) | Ratio of Justified Complaints per 10,000 enrollees |
|---|---|---|---|---|
| AECC TOTAL VISION HEALTH PLAN OF TEXAS, INC. | 6 | 4 | 441,217 | 0.09 |
| AETNA U.S. HEALTHCARE DENTAL PLAN INC. | 1 | 1 | 26,343 | 0.38 |
| ALPHA DENTAL PROGRAMS, INC. | 3 | 2 | 52,821 | 0.38 |
| CIGNA DENTAL HEALTH OF TEXAS, INC. | 13 | 10 | 312,794 | 0.32 |
| DENTAL BENEFITS, INC. | 1 | 1 | 0 | N/A |
| DENTICARE, INC. | 5 | 2 | 136,399 | 0.15 |
| MAGELLAN BEHAVIORAL HEALTH OF TEXAS, INC. | 12 | 8 | 600,709 | 0.13 |
| NATIONAL PACIFIC DENTAL, INC. | 6 | 2 | 147,608 | 0.14 |
| NYLCARE DENTAL PLANS OF THE SOUTHWEST, INC. | 3 | 1 | 0 | N/A |
| PRUDENTIAL DENTAL MAINTENANCE ORGANIZATION, INC. | 23 | 11 | 532,026 | 0.21 |
| SAFEGUARD HEALTH PLANS, INC. | 24 | 19 | 191,360 | 0.99 |
| UNITED DENTAL CARE OF TEXAS, INC. | 11 | 4 | 261,564 | 0.15 |
| VALUEOPTIONS OF TEXAS, INC. | 1 | 1 | 70,841 | 0.14 |
| Average for Single and Limited Service HMOs | 0.26 | |||
| Total for all HMOs | 5,746 | 3,507 | ||
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Last updated: 11/01/2006
