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How do HMOs rank based on complaints to the New York State Insurance Department?
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| Click here for the pdf version of the table |
| HMO | Rank | Total Complaints to NYSID |
Upheld Complaints to NYSID |
Premium (Millions $) |
Complaint Ratio |
Total Complaints to DOH1 | Upheld Complaints to DOH |
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| Aetna Health | 11 | 485 | 173 | $779.8 | 0.222 | 3 | 0 | |
| Atlantis2 | -- | -- | -- | -- | -- | -- | -- | |
| CDPHP | 5 | 82 | 9 | $651.1 | 0.014 | 3 | 0 | |
| CIGNA | 12 | 80 | 34 | $117.2 | 0.290 | 2 | 0 | |
| Community Blue (HealthNow) | 4 | 86 | 14 | $1,037.5 | 0.014 | 13 | 0 | |
| Empire HealthChoice | 7 | 689 | 75 | $1,819.3 | 0.041 | 8 | 0 | |
| Excellus | 3 | 134 | 20 | $1,893.3 | 0.011 | 14 | 2 | |
| GHI-HMO Select | 10 | 133 | 29 | $132.5 | 0.219 | 21 | 2 | |
| Health Net of NY | 13 | 766 | 300 | $437.8 | 0.685 | 8 | 3 | |
| HIP | 9 | 1,536 | 728 | $4,127.6 | 0.176 | 50 | 0 | |
| IHA | 1 | 27 | 4 | $586.9 | 0.007 | 11 | 2 | |
| MDNY | 15 | 271 | 236 | $93.8 | 2.515 | 8 | 0 | |
| MVP Health Plan | 2 | 111 | 8 | $944.3 | 0.009 | 1 | 0 | |
| Oxford | 8 | 1,195 | 279 | $1,928.8 | 0.145 | 22 | 0 | |
| Rochester Area HMO (Preferred Care) | 6 | 18 | 5 | $321.6 | 0.016 | 1 | 0 | |
| UnitedHealthcare of NY | 14 | 59 | 25 | $28.6 | 0.875 | 5 | 0 | |
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| Total | 5,672 | 1,939 | 14,900.7 | Avg.=0.349 | 171 | 9 | ||
| NOTE: The complaint ratio does not include Department of Health (DOH) complaints. |
1 |
DOH complaint data is from 2006 |
2 |
Atlantis Health Plan has the minimum premium required to report data, but did not report the data by the deadline, so the data are not reported in this Guide. |
Understanding the Table
You will find information about complaints against HMOs that were reviewed and closed by the New York State Insurance Department in the year 2006.
Each year, New York State receives complaints about HMOs from consumers and health care providers. After reviewing each complaint, the State decides if the HMO acted appropriately. If not they must remedy the problem. Complaints to the Insurance Department typically involve issues concerning payment, reimbursement, coverage, benefits, and premiums.
The tables rank HMOs by their complaint ratio from best (lowest ratio) to worst (highest ratio). For each HMO, the table tells you:
Rank based on complaint ratio - HMOs ranked by their complaint ratio from best (lowest ratio) to worst (highest ratio). A better ranking means that the HMO had fewer upheld complaints relative to its size.
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Total Complaints to NYSID - Total number of complaints about HMOs closed by NYSID. Complaints to the NYSID involve issues concerning payment, reimbursement, coverage, benefits, and premiums.
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Upheld Complaints to NYSID - Number of complaints closed by the NYSID that are decided in favor of the consumer or provider. Remember that only complaints upheld by the Insurance Department are used to calculate the complaint ratio and ranking.
Total Complaints to DOH - Total number of complaints about HMOs closed by the Department of Health (DOH). Complaints to the DOH involve concerns about the quality of care received by HMO members.
Upheld Complaints to DOH - Number of complaints closed by the DOH that are decided in favor of the consumer or provider. The number in this column is not used to calculate an insurer's complaint ratio and ranking.
Premium* - Dollar amount of premiums generated by an HMO in New York during 2006. Premiums are used in calculating the complaint ratio so that different sized HMOs can be compared fairly.
Complaint Ratio - Number of upheld complaints divided by an HMO's annual premium.
* Premium and Membership data exclude Medicare and Medicaid.
Keep in mind...
HMOs with a larger premium typically have more members and therefore more complaints than smaller HMOs.
Make a decision based on the priorities you have for your family's health care. The Complaints category is only one of eight performance areas presented.
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