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HMO	Rank	Total Complaints to NYSID	Upheld Complaints to NYSID	Premium (Millions $)	Complaint Ratio	Total Complaints to DOH1	Upheld Complaints to DOH
Aetna Health Inc.	11	548	137	$635.9	0.2155	4	1
Atlantis Health Plan	12	148	103	$66.1	1.5584	5	2
CDPHP	4	86	14	$648.9	0.0216	5	0
Community Blue (HealthNow)	6	91	32	$471.8	0.0678	26	2
Empire HealthChoice HMO, Inc.	7	742	176	$1,775.3	0.0991	6	4
Excellus Health Plan, Inc. (HMO)	5	128	31	$847.6	0.0366	30	8
GHI HMO Select, Inc.	13	355	189	$86.5	2.1853	8	2
Health Net of NY, Inc.	8	301	66	$465.0	0.1419	19	3
HIP HMO	10	1,170	488	$2,351.9	0.2075	31	12
Independent Health Association, Inc. (IHA)	2	21	2	$485.6	0.0041	19	7
MVP Health Plan, Inc.	3	74	9	$861.6	0.0104	9	7
Oxford Health Plans of NY, Inc.	9	1,360	196	$1,342.8	0.1460	25	14
Rochester Area HMO, Inc. (Preferred Care)	1	1	0	$385.3	0.0000	6	1
Total		5,025	1,443	10424.3	Avg. = 0.1384	193	63

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 2008.

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.

• 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.

• 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 2008. 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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