New York State
Insurance Department
 

DEPARTMENT RANKS HEALTH INSURERS ACCORDING TO COMPLAINTS


New York, December 24, 1997 

Superintendent of Insurance Neil D. Levin today released the Department’s annual rankings of consumer complaints against health insurance companies. The report consists of four separate rankings. HMOs, nonprofit indemnity plans (e.g. blue cross and blue shield plans) and commercial companies are each ranked separately and an overall ranking includes all insurers in each of these three rankings. 

A total of 57 groups or companies are listed in the rankings (24 commercial insurers, 27 HMOs, and 6 nonprofit carriers). Those companies ranked at the top of the lists have the least complaints relative to their size. 

The company with the lowest complaint ratio in the overall ranking is U.S. Health Insurance Company with no complaints. However, this company does not offer a comprehensive health insurance product. The company with the highest complaint ratio in the overall ranking is NYLCare Health Plans of New York with 41 upheld complaints. 

Three of the largest carriers showed significant improvement over 1995 in the overall ranking. Empire Blue Cross & Blue Shield (a nonprofit), moved from #52 to #32 primarily due to a 79% drop in complaints upheld. HIP moved from last place (#60) in 1995 to #52 in 1996 based on a 68% decline in number of upheld complaints and little change in premium. Group Health Inc. (GHI), also a nonprofit, improved its standing from #59 in 1995 to #51 in 1996 with a decrease of 36% in complaints upheld and a slight decline in premium. These three companies together accounted for 39% of total complaints upheld in 1996, down from 64% in 1995. 

Nonprofit Indemnity Plans 

Excellus Health Plan, Inc. and Finger Lakes Insurance Companies top the 1996 list, as they did in 1995, with complaint ratios of 1.50 and 1.91, respectively. Finger Lakes is comprised of the Finger Lakes Health Insurance Company and the Finger Lakes Medical Insurance Company. The highest ratios were recorded by the two largest nonprofit carriers, Group Health Inc. (GHI), and Empire Blue Cross & Blue Shield. 

The six nonprofit indemnity insurers are ranked as follows: 

Complaint
Ratio
Complaints
Upheld
Complaints
Total
Claims
(in millions)
1 Excellus Health Plan, Inc. 1.50 9 75 6.0
2 Finger Lakes 1.91 6 39 3.1
3 New York Care Plus Ins. Co. 3.47 24 132 6.9
4 Utica-Watertown Health Ins. Co. 6.31 13 58 2.1
5 Empire B/C & B/S 9.69 139 1,064 14.3
6 Group Health Inc., (GHI) 15.89 227 750 14.3

HMOs 

Five of the top eight HMOs in 1996 were also among the top eight the year before. United Healthcare of Upstate New York ranked number one, with no upheld complaints. Four other companies followed with one complaint each: Blue Choice; Rochester Area HMO (Preferred Care); The Health Care Plan, Inc.; and Health Services Medical of Central New York. 

The largest year-to-year increase in the number of upheld complaints among all HMOs was reported by Oxford Health Plans, New York’s largest HMO. Oxford’s upheld complaints rose from 52 in 1995 to 134 in 1996, a 158% increase. On the other hand, the State’s second-largest HMO, HIP, improved considerably over the year with the number of upheld complaints falling from 636 in 1995 to 203 in 1996. The number of upheld complaints against U.S. Healthcare, the State’s third-largest HMO, increased by 50% over the year, from 42 in 1995 to 63 in 1996. 

The three HMOS with the lowest complaint ratios are:

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
1 United Healthcare of Upstate NY 0.00 0 3 $ 40.0
2 Blue Choice 0.00 1 24 663.1
3 Rochester Area HMO 0.00 1 13 221.5

 The three HMOs with the highest complaint ratios are:

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
27 NYLCare Health Plans of NY 0.30 41 106 $ 135.9
26 CIGNA Healthcare of NY 0.22 19 47 85.2
25 Prudential Health Care Plan of NY 0.20 22 70 112.1

 Commercials 

Three companies are tied for first place among the commercial health insurers with no upheld complaints. They are ranked in order of premium, with U.S. Health Insurance Company first, followed by Zurich-American and Principal Mutual Life. Certain companies such as Zurich-American, the number-two-ranked group, primarily write disability insurance. Others such as U.S. Health Insurance Company (the number-one-ranked carrier) and Oxford Health Insurance (#24) primarily provide coverage for HMO point-of-service subscribers who choose to use non-network doctors. In addition, Principal Mutual Life no longer offers comprehensive health insurance in New York State. 

The three commercial insurers with the lowest complaint ratios are: 

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
1 U.S. Health Insurance Co. 0.00 0 0 $ 67.7
2 Zurich-American Ins. Cos. 0.00 0 1 59.6
3 Principal Mutual Life 0.00 0 10 52.4

The three commercial insurers with the highest complaint ratios are:

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
24 Oxford Health Insurance 0.24 85 213 $ 359.2
23 Chubb & Son, Inc. 0.19 16 65 86.0
22 Aetna Life & Casualty 0.16 33 149 207.2

 

Overall Ranking

 The companies in the overall ranking with the lowest complaint ratios are:

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
1 U.S. Health Insurance Co. 0.00 0 0 $ 67.7
2 Zurich-American Ins. Cos. 0.00 0 1 59.6
3 Principal Mutual Life Ins. Co. 0.00 0 10 52.4

The three companies in the overall ranking with the highest complaint ratios are:

Complaint
Ratio
Complaints
Upheld
Complaints
Total
NYS Prem.
(in millions)
57 NYLCare Health Plans of NY 0.30 41 106 $ 135.9
56 Oxford Health Insurance 0.24 85 213 359.2
55 CIGNA Healthcare of NY 0.22 19 47 85.2

The Department encourages any New Yorker unable to resolve a complaint against an insurance company, broker, agent or adjuster to contact our Consumer Services Bureau. The toll-free number is 800-342-3736. 

A complete copy of the rankings will be available on the Department’s Website at www.ins.state.ny.us or by writing the Department’s Publications Unit at Agency Building #1, Empire State Plaza, Albany, NY 12257. Complaint forms can also be printed from the Website.


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