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.