Press Release 1999-21 Arizona Department of Insurance Publishes HMO Complaint Ratios

Don Harris, Public Information Officer, (602) 912-8402

For Immediate Release September 29, 1999

As a consumer service, the Arizona Department of Insurance has published for the first time complaint ratios for managed health care organizations. The publication contains complaint ratios for 11 health maintenance organizations, seven pre-paid dental plans and four non-profit service corporations.

These ratios represent the number of written complaints received by the Insurance Department per 1,000 individuals covered by each organization during the 1998 calendar year. Both the total number of enrollees and the written complaints are shown in this free publication.

Arizona Insurance Director Charles R. Cohen said, “Complaint ratios assist consumers by providing a record of complaints lodged against managed care organizations in Arizona. The complaint ratios do not reflect a determination by the Insurance Department regarding the merits of each complaint, but merely represent the total number of written complaints received by the Department against individual companies during 1998.

“Consumers can use this publication to have a better understanding of how enrollees believe a particular managed care organization is treating its members,” Cohen said. “It is an excellent tool for comparison shopping for managed care coverage.”

Complaint ratios are used by the Insurance Department to identify potential problems requiring regulatory action, which might include an examination of an insurer’s business practices. The ratios help to assess an individual company’s performance over an entire year and to identify developing long-term trends that may have a negative impact on consumers.

The complaint ratio is achieved by dividing the number of individuals covered into the number of complaints, and multiplying the answer by 1,000. For example, a company with policies covering 20,000 individuals that receives 15 complaints would have a complaint ratio of 0.75.

Anyone who wants a copy of the complaint ratio may obtain the publication by visiting the Insurance Department web page at www.state.az.us\id or by calling or writing to: Arizona Department of Insurance, Consumer Assistance, 2910 N. 44th Street, Suite 210, Phoenix, AZ 85018; (602) 912-8444 (Phoenix); (800) 325-2548 (Statewide), (520) 628-6370 (Tucson).

(Complete Complaint Ratio Chart is on the Next Page)

1998 COMPLAINT RATIO - MANAGED CARE

COMPANY NAME

HEALTHCARE, DENTAL OR VISION

MEDIGAP

MEDICARE RISK

TOTAL ENROLLEES

COMPLAINTS

RATIO

 

Enrollees

Enrollees

Enrollees

 

Health Care Services Organizations

AETNA U.S. HEALTHCARE, INC.

66,776

0

1,433

68,209

36

0.528

CIGNA HEALTHCARE OF ARIZONA, INC.

343,622

9

39,503

383,134

70

0.183

FIRST HEALTH OF ARIZONA, INC.

0

671

0

671

0

0

HEALTH PLAN OF NEVADA, INC.

129

0

5,205

5,334

3

0.562

HEALTHPARTNERS HEALTH PLANS, INC.  *

281,848

114

29,547

311,509

54

0.173

HUMANA HEALTH PLAN, INC.

22,427

545

22,921

45,893

21

0.458

INTERGROUP PREPAID HEALTH SERVICES OF ARIZONA, INC.

284,792

0

51,280

336,072

122

0.363

MAYO HEALTH PLAN ARIZONA

8,384

0

0

8,384

0

0

PACIFICARE OF ARIZONA, INC.

107,142

20

88,064

195,226

95

0.487

PREMIER HEALTHCARE, INC.

45,932

0

12,664

58,596

22

0.375

UNITED HEALTHCARE OF ARIZONA, INC.

79,772

0

0

79,772

24

0.301

SUBTOTALS

1,240,824

1,359

250,617

1,492,800

447

 

Prepaid Dental Plans

CIGNA DENTAL HEALTH PLAN OF ARIZONA, INC.

117,963

0

11,222

129,185

0

0

EMPLOYERS DENTAL SERVICES, INC.

2,124,548

0

0

2,124,548

1

0

PREMIER CHOICE DENTAL, INC.

7,607

0

0

7,607

0

0

PRIVATE MEDICAL-CARE OF ARIZONA, INC.

696

0

0

696

0

0

SAFEGUARD HEALTH PLANS, INC.

975

0

0

975

0

0

TOTAL DENTAL ADMINISTRATORS HEALTH PLAN, INC.

4,580

0

0

4,580

0

0

UNITED DENTAL CARE OF ARIZONA, INC.

227,042

0

0

227,042

11

0.048

SUBTOTALS

2,483,411

0

11,222

2,494,633

12

 

Non-Profit Service Corporations

BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC.

564,396

24,112

9,233

597,741

97

0.162

DELTA DENTAL PLAN OF ARIZONA, INC.

452,126

0

0

452,126

7

0.015

SIGHTCARE, INC.

26,713

0

0

26,713

0

0

VISION SERVICE PLAN OF ARIZONA, INC.

434,053

0

0

434,053

1

0.002

SUBTOTALS

1,477,288

24,112

9,233

1,510,633

105

 

TOTALS

5,201,523

25,471

271,072

5,498,066

564

 

* Acquired by United Healthcare Corp., October 1, 1998;
  Merged into United Healthcare of Arizona, Inc., March 31, 1999.

 

Period: 
1999
Priority: 
21

Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an naic.org or gmail.com email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].