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Health Guide Complaints

Health Guide Ranking

Utilization Review Requests, Decisions, and Appeals Independent External Review
Health Guide Complaints Health Guide Contacts Health Guide

 

Four performance areas are presented in this Interactive Guide. Select from the toolbar above to view each of the comparative charts. Below each chart is a description on how to read and understand the results.

Complaints Received by the Company (January 2010 - December 2010)

Insurer/HMO

Total Number of Covered Persons

Number of Complaints Received from Covered Persons

Number of Complaints that were Decided in Favor of the Covered Person after a Review and the Reversal Rate (see explanation below)

Aetna Health, Inc.        
Anthem Health Plans of Maine, Inc. 297,169 2,077 327 16%
CIGNA HealthCare of Maine, Inc. 2 1 1(partial) 100%
Connecticut General Life Insurance Co 79,018 55 11 20%
Guardian Life Insurance Co of America        
Harvard Pilgrim Health Care 45,861 88 31 35%
John Alden Life Insurance Company        
MEGA Life & Health Insurance Company        
Securian Life Insurance Co (Dental Coverage Only)        
Trustmark Life Insurance Company        
United Healthcare Insurance Company        

COMPLAINTS RECEIVED BY THE COMPANIES

A complaint is a written complaint against an insurer. The complaint may be filed by the person who is covered under the health insurance plan or by someone else on behalf of the insured person.

Please note: The chart above shows complaints received by the insurer where the covered person (or someone on behalf of the covered person) was not happy with a decision of the insurer/HMO. The Reversal Rate is the percentage of insurer/HMO decisions that were made against the covered person and then were reversed after another review. For example, a 50% reversal rate shows that in 5 out of 10 complaints received, the insurer/HMO changed its initial adverse decision in favor of the covered person.


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Last Updated: August 22, 2012