|
The following
information is Michigan HMO Complaint Data for the year 2003. Complaints can range from a
consumer disagreeing with a denial of service to dissatisfaction with the
service they received. An HMO is responsible for reviewing and responding
to all complaints.
Please note that
Medicaid members also have an external complaint process with the Michigan
Department of Community Health (MDCH). This chart does not contain
information from MDCH.
| Definitions: |
Internal |
|
The
first formal review process conducted by the HMO |
| |
External |
|
The
review process conducted by OFIS after a consumer has completed the
HMOs internal review process. This process is called the Patients
Right to Independent Review Act (PRIRA). |
| |
Upheld |
|
The
decision of the HMO was upheld by the process. |
| |
Overturned |
|
The
decision of the HMO was overturned by the process. |
| |
Compromise |
|
A
mutually agreeable decision was reached. |
| |
Resolved |
|
The final
adverse determination was reversed prior to a formal decision by
OFIS. |
f you have questions,
please contact the Office of Financial and Insurance Services toll free at
877-999-6442. |
|
HMO
Complaint Information |
| |
Internal* |
External** |
|
HMO |
Upheld |
Overturned |
Compromise |
Total |
Annualized
Complaints per 1000
Members |
Upheld |
Overturned |
Resolved |
Total |
| Aetna
Health, Inc. |
17 |
10 |
0 |
27 |
5.5 |
1 |
1 |
0 |
2 |
| Blue Care
Network of MI |
616 |
799 |
13 |
1428 |
2.9 |
14 |
8 |
1 |
23 |
| Cape
Health Plan, Inc. |
10 |
0 |
113 |
123 |
2.0 |
0 |
0 |
0 |
0 |
| Care
Choices HMO MI |
53 |
30 |
40 |
123 |
1.2 |
3 |
1 |
0 |
4 |
| Community
Choice MI |
20 |
11 |
0 |
31 |
0.5 |
0 |
0 |
0 |
0 |
| Grand
Valley Health Plan, Inc. |
9 |
4 |
7 |
20 |
1.1 |
0 |
1 |
0 |
1 |
| Great
Lakes Health Plan |
8 |
8 |
2 |
18 |
0.2 |
0 |
0 |
0 |
0 |
| Health
Alliance Plan of MI |
252 |
503 |
124 |
879 |
1.9 |
12 |
3 |
1 |
16 |
| Health
Plan of MI |
38 |
19 |
108 |
165 |
2.9 |
3 |
0 |
0 |
3 |
| HealthPlus of MI, Inc. |
134 |
169 |
59 |
362 |
3.4 |
0 |
0 |
0 |
0 |
| HealthPlus Partners |
20 |
31 |
24 |
75 |
1.3 |
0 |
0 |
0 |
0 |
| M-CAID |
13 |
10 |
8 |
31 |
2.1 |
0 |
0 |
0 |
0 |
| M-CARE |
384 |
438 |
126 |
948 |
4.9 |
5 |
0 |
0 |
5 |
| McLaren
Health Plan, Inc. |
82 |
0 |
0 |
82 |
3.2 |
0 |
0 |
0 |
0 |
| Midwest
Health Plan, Inc. |
1,208 |
0 |
0 |
1,208 |
26.8 |
0 |
0 |
0 |
0 |
| Molina |
494 |
0 |
0 |
494 |
10.1 |
0 |
0 |
0 |
0 |
| OmniCare
Health Plan |
0 |
0 |
0 |
0 |
0.0 |
0 |
0 |
0 |
0 |
| Paramount
Care of MI |
20 |
6 |
10 |
36 |
5.7 |
1 |
0 |
0 |
1 |
| PHP of
Mid-Michigan |
352 |
395 |
0 |
747 |
10.7 |
12 |
7 |
4 |
23 |
| PHPMM-Family Care |
33 |
97 |
0 |
130 |
7.0 |
0 |
0 |
0 |
0 |
| PHP of
South Michigan |
15 |
30 |
1 |
46 |
1.6 |
0 |
0 |
0 |
0 |
| Physicians H. Plan of SW MI |
12 |
5 |
0 |
17 |
0.5 |
3 |
0 |
0 |
3 |
| Priority
Health Govt. Programs |
10 |
1 |
0 |
11 |
0.4 |
0 |
0 |
0 |
0 |
| Priority
Health Plan |
363 |
129 |
10 |
502 |
1.6 |
8 |
2 |
0 |
10 |
| ProCare
Health Plan, Inc. |
0 |
0 |
0 |
0 |
0.0 |
0 |
0 |
0 |
0 |
| Total
Health Care, Inc. |
14 |
16 |
35 |
65 |
1.2 |
0 |
0 |
0 |
0 |
| Ultimed
HMO |
0 |
0 |
0 |
0 |
0.0 |
0 |
0 |
0 |
0 |
| Upper
Peninsula Health Plan |
261 |
2 |
2 |
265 |
10.2 |
0 |
0 |
0 |
0 |
| Total |
4,438 |
2,713 |
682 |
7,833 |
3.11 |
62 |
23 |
6 |
91 | |