ConnectiCare Inc., the largest HMO as ranked by premiums written among six operating in Connecticut, also had the best complaint record in 2008 for the fourth straight year.
The Connecticut Insurance Department (CID) publishes annual complaint data on the eve of most companies entering open enrollment period for health plans, during which employees can choose new options and in some cases new carriers.
Policyholders filed just a dozen justifiable complaints in 2008 against Farmington-based ConnectiCare, which is a subsidiary of New York City-based EmblemHealth Inc. Most of those complaints concerned the processing of claims; CID also reviews complaints on underwriting, marketing, policy service and other areas.
Since 2005 when Trumbull resident Mickey Herbert became president, ConnectiCare has remained atop the HMO complaint ratio rankings.
Hartford-based Aetna Inc. had the worst complaint ratio among Connecticut HMOs, sustaining 50 complaints from its premium base of $171 million. While Health Net Inc. had a few more complaints lodged against it last year, its HMO does triple the business of Aetna”™s in Connecticut.
Â
Health Net”™s Shelton-based Northeast operations are in the process of being acquired by UnitedHealth Group Inc., the corporate parent of Trumbull-based Oxford Health Plans Inc. whose complaint ratio nearly tripled between 2007 and 2008.
Â
In addition to health insurers, CID assesses life and accident insurers in its annual complaint rankings.
On the flip side, Aetna”™s non-HMO operations registered a single complaint while writing more than $200 million in business, and Health Net”™s non-HMO health insurance arm cleared the year without registering a complaint, the largest of more than 120 distinct entities to do so.
The study did not include complaint ratio data for the HMO operations of Anthem Blue Cross & Blue Shield; the Wellpoint Inc. subsidiary”™s overall score would have placed it third overall if included among the HMO rankings.
Aetna is in the process of hiking rates to cover unexpected increases in preventative care driven both by the swine flu outbreak and by some of its members going onto COBRA benefits after losing their jobs.
Aetna also said it has increased its scrutiny of bills sent it by doctors, clinics and hospitals.
“For the last couple of quarters we have been doing a lot of audits, where we believe there is the potential for some confusion around the way providers have billed us,” said Mark Bertolini, president of Aetna, in a conference call late last month with investment analysts. “We always assume positive intent going into these situations, and want to make sure that we understand how those bills are coming in ”¦ A number of these issues can be handled through claim-payment policies. So, for example, where we are seeing multiple office visits billed at the same office visit, we are reducing the reimbursement for the second visit in that visit.”
