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HMO Complaints



HMO Complaint Information

Total Level One Determinations* External PRIRA Determinations**
Name of HMO
Upheld
Overturned
Compromise
Total
Annualized level one complaints per 1,000 members
Upheld
Overturned
Resolved
Other#
Total
Aetna Health, Inc. 8 2 0 10 40,000 0 0 0 0 0
BlueCaid of MI 6 3 1 10 0.5 0 0 0 0 0
Blue Care Network of MI 1,121 681 14 1,816 3.3 21 7 0 0 28
CareSource Michigan 7 2 93 102 2.0 0 0 0 0 0
Fidelis SecureCare of MI, Inc. 33 4 10 47 41.6 0 0 0 0 0
Grand Valley Health Plan, Inc. 7 1 1 9 1.0 0 0 0 0 0
Great Lakes Health Plan 48 54 243 345 2.0 0 0 0 0 0
Health Alliance Plan of MI 237 732 124 1,093 2.8 2 3 0 0 5
Health Plan of MI 122 76 0 198 1.3 0 0 0 0 0
HealthPlus of MI, Inc. 89 83 36 204 2.4 0 0 0 0 0
HealthPlus Partners 18 16 6 40 0.6 0 0 0 0 0
McLaren Health Plan, Inc. 90 0 0 90 1.4 0 0 0 0 0
Midwest Health Plan, Inc. 0 0 340 340 5.3 0 0 0 0 0
Molina Healthcare of MI, Inc. 60 47 1,281 1,388 6.6 0 0 0 0 0
OmniCare Health Plan 162 2 0 164 3.0 0 0 0 0 0
Paramount Care of MI 16 37 31 84 12.0 1 1 0 0 2
PHP of Mid-Michigan 182 288 0 470 11.0 14 2 0 0 16
PHPMM-Family Care 9 29 0 38 2.3 0 0 0 0 0
PHP of South Michigan 6 6 0 12 8.2 1 0 0 0 1
Priority Health Govt. Programs 7 0 0 7 0.1 0 0 0 0 0
Priority Health Plan 405 77 9 491 1.4 9 2 0 0 11
ProCare 0 0 3 3 6.3 0 0 0 0 0
Total Health Care, Inc. 65 15 8 88 1.6 0 0 0 0 0
Total Health Care, USA 8 7 2 17 1.1 0 0 0 0 0
Upper Peninsula Health Plan 15 0 0 15 0.6 0 0 0 0 0
Year 2008 Total 2,721 2,162 2,202 7,085 2.9 48 15 0 0 63
Percent of Decisions 38.4% 30.5% 31.1%
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