InsuranceComplaintCheck

SCOTT AND WHITE HEALTH PLAN — health Insurance Complaints

Analysis of 1,273 health insurance complaints filed against SCOTT AND WHITE HEALTH PLAN, based on public NAIC and state DOI data.

Key Statistics

  • health Complaints: 1,273
  • Total Complaints (All Types): 1,273
  • health Share: 100.0%
  • NAIC Complaint Ratio: 12.82
  • AI Risk Score: 91/100

health Complaint Issues

Issue TypeComplaints% of Total
Claim denial46936.8%
Delayed payment30624.0%
Premium or billing dispute1249.7%
Usual And Customary | Contract Language/Legal Issue272.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue272.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction171.3%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue131.0%
Policy cancellation100.8%
Unsatisfactory Settle/Offer | No Jurisdiction90.7%
Unsatisfactory Settle/Offer; Usual And Customary | Company Position Upheld80.6%
Coverage dispute70.5%
Unsatisfactory Settle/Offer; Usual And Customary | Insufficient Information60.5%
Unfair settlement50.4%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Information Furnished50.4%
Other | Information Furnished40.3%
Cust Service Claim Handling | Information Furnished; Contract Language/Legal Issue40.3%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Contract Language/Legal Issue40.3%
Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language/Legal Issue; Information Furnished30.2%
Unsatisfactory Settle/Offer | Information Furnished; Contract Language/Legal Issue30.2%
Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken30.2%
Cust Service Claim Handling | Company Position Upheld30.2%
Usual And Customary | No Jurisdiction30.2%
Unsatisfactory Settle/Offer | Additional Monies Received; Claim Settled30.2%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; No Jurisdiction30.2%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Corrective Action Taken30.2%
Access to Care | No Jurisdiction30.2%
Cust Srvc Policy Holder Srvcs | Information Furnished; Question of Fact20.2%
Cust Service Claim Handling | Contract Language/Legal Issue; Information Furnished20.2%
Authorization Dispute; Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language/Legal Issue; Information20.2%
Unsatisfactory Settle/Offer | Corrective Action Taken; Information Furnished20.2%
Unsatisfactory Settle/Offer | Additional Payment Expected; Information Furnished; Corrective Action Taken20.2%
Prior Authorization | Contract Language/Legal Issue; Information Furnished20.2%
Provider or network dispute20.2%
Commissions | Information Furnished20.2%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished20.2%
Other | Information Furnished; Contract Language/Legal Issue20.2%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished20.2%
Claim Recoding/Bundling; Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Payment Expected20.2%
Cust Service Claim Handling | Information Furnished20.2%
Unsatisfactory Settle/Offer | Information Furnished; No Jurisdiction20.2%
Unsatisfactory Settle/Offer | Insufficient Information; Record Only20.2%
Other | No Jurisdiction20.2%
Not Within TDI Jurisdiction; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; No Jurisdiction20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Monies Received; Contract Language/Legal Issue20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; No Jurisdiction20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Information Furnished; No Jurisdiction20.2%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Company Position Upheld20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Company Position Upheld; No Jurisdiction20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Claim Settled; Contract Language/Legal Issue20.2%
Not Within TDI Jurisdiction; Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; No Jurisd20.2%
Unsatisfactory Settle/Offer | Claim Settled20.2%
Claims Reimb/Bal Bill Problems; PPACA-Out-Of-Ntwk Emerg Care; Unsatisfactory Settle/Offer | Mediation Paid Amount; Media20.2%
Unsatisfactory Settle/Offer | Information Furnished20.2%
Cust Srvc Policy Holder Srvcs | Referred To; Contract Language/Legal Issue; Information Furnished10.1%
Prior Authorization | Information Furnished10.1%
Commissions | Information Furnished; Contract Language/Legal Issue; Company Position Upheld10.1%
Maximum Out of Pocket | Information Furnished; Contract Language/Legal Issue; Company Position Upheld10.1%
Access to Care; Cust Srvc Policy Holder Srvcs | Corrective Action Taken; Information Furnished10.1%
Other | Insufficient Information10.1%
Unauthorized Acts | Information Furnished10.1%
Recoupment Of Claims Payment | Company Position Upheld; Information Furnished; Contract Language/Legal Issue10.1%
Prior Authorization | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Authorization Dispute; Unsatisfactory Settle/Offer | Additional Payment Expected; Corrective Action Taken; Information F10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Additional Payment Expected; Corrective Action10.1%
Commissions | Contract Language/Legal Issue; No Jurisdiction10.1%
Commissions | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Cust Srvc Policy Holder Srvcs | Contract Language/Legal Issue; Information Furnished10.1%
Cust Service Claim Handling; Misrepresentation; Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language10.1%
Cust Service Claim Handling | Information Furnished; Contract Language/Legal Issue; Company Position Upheld10.1%
Cust Srvc Policy Holder Srvcs | Question of Fact; Information Furnished10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language/Legal Issue; Infor10.1%
Cust Srvc Policy Holder Srvcs | Information Furnished; Corrective Action Taken10.1%
Cust Srvc Policy Holder Srvcs; Prior Authorization | Company Position Upheld; Contract Language/Legal Issue10.1%
Cust Srvc Policy Holder Srvcs; Prior Authorization | Information Furnished; Contract Language/Legal Issue; Company Posit10.1%
Cust Service Claim Handling; Maximum Out of Pocket | Information Furnished; Contract Language/Legal Issue; Company Posit10.1%
Recoupment Of Claims Payment | Corrective Action Taken; Additional Payment Expected; Information Furnished10.1%
Timely Filing Deficiency; Unsatisfactory Settle/Offer | Information Furnished; Company Position Upheld; Contract Languag10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Company Position Upheld; Infor10.1%
Unsatisfactory Settle/Offer | Corrective Action Taken; Information Furnished; Additional Payment Expected10.1%
Cust Service Claim Handling | Corrective Action Taken10.1%
Hlth Care Svcs Covg/Copay/Lmts | Contract Language/Legal Issue; Information Furnished10.1%
Commissions | Corrective Action Taken; Information Furnished10.1%
Prior Authorization | Contract Language/Legal Issue; Corrective Action Taken; Information Furnished10.1%
Unsatisfactory Settle/Offer | Complaint Withdrawn; Corrective Action Taken; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | Information Furnished; Company Position Upheld; Contract Language/Legal Issue10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Company Position Upheld; Information Furnished; Contract Lang10.1%
Pediatric Care; Unsatisfactory Settle/Offer | Additional Payment Expected; Corrective Action Taken; Claim Settled10.1%
Endorsement / Rider; Essential Health Benefit | Contract Language/Legal Issue; Company Position Upheld; Information Furn10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Claim Settled; Information Fur10.1%
Cust Service Claim Handling; Maximum Out of Pocket | Information Furnished; Corrective Action Taken10.1%
Recoupment Of Claims Payment | Contract Language/Legal Issue; Information Furnished10.1%
Access to Care | Insufficient Information; Record Only10.1%
Claim Recoding/Bundling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished10.1%
Unauthorized Acts | Information Furnished; Contract Language/Legal Issue10.1%
Usual And Customary | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Claim Recoding/Bundling; Unsatisfactory Settle/Offer | Additional Monies Received; Claim Settled; Corrective Action Take10.1%
Claim Recoding/Bundling; Other; Unsatisfactory Settle/Offer | Policy Not In Force; Information Furnished10.1%
Claim Recoding/Bundling; Other; Unsatisfactory Settle/Offer | Information Furnished; Additional Payment Expected; Correc10.1%
Claim Recoding/Bundling; Other; Unsatisfactory Settle/Offer | Additional Payment Expected; Corrective Action Taken; Clai10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Corrective Action Taken; Claim Settled; Company Position Uphe10.1%
Other | Corrective Action Taken; Contract Language/Legal Issue; Information Furnished10.1%
Maximum Out of Pocket; Unsatisfactory Settle/Offer | Additional Payment Expected; Information Furnished; Corrective Acti10.1%
Recoupment Of Claims Payment | Information Furnished10.1%
Bad Faith Participation | No Jurisdiction10.1%
Maternity and Newborn Care; Unsatisfactory Settle/Offer | Information Furnished; Additional Payment Expected; Contract L10.1%
Cust Service Claim Handling; Maximum Out of Pocket; Unsatisfactory Settle/Offer10.1%
Essential Health Benefit; Unsatisfactory Settle/Offer | Referred To; Contract Language/Legal Issue; No Jurisdiction10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Stat Pen Pd-Over 90 Dys Late; Corrective Action Taken; Claim Settled10.1%
Unsatisfactory Settle/Offer | No Jurisdiction; Referred To; Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer | Referred To; No Jurisdiction10.1%
Unsatisfactory Settle/Offer | No Jurisdiction; Referred To10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Other | Contract Language/Legal Issue; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | Insufficient Information10.1%
Unsatisfactory Settle/Offer | Mediation Not Eligible; Mediation Billed Amount10.1%
Timely Filing Deficiency | Contract Language/Legal Issue10.1%
Usual And Customary | Insufficient Information; Record Only10.1%
Usual And Customary | No Jurisdiction; Corrective Action Taken10.1%
Coordination of Benefits | No Jurisdiction10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Not Within TDI Jurisdiction | No Jurisdiction10.1%
Access to Care | Company Position Upheld10.1%
Unsatisfactory Settle/Offer | Record Only10.1%
Usual And Customary | Record Only10.1%
IRO Compnsblty/Extent Decision | Corrective Action Taken10.1%
Cust Service Claim Handling; Den/N-Pymt MD Nec RX; Unsatisfactory Settle/Offer | Insufficient Information10.1%
Access to Care | Contract Language/Legal Issue10.1%
Claims Reimb/Bal Bill Problems; Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Additi10.1%
Unfair Discrim-Clms Handling | Contract Language/Legal Issue10.1%
Laboratory Services; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Access to Care; Continuity of Treatment | Information Furnished; Policy Not In Force10.1%
Unsatisfactory Settle/Offer | Corrective Action Taken; Contract Language/Legal Issue; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | Information Furnished; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | No Jurisdiction; Additional Monies Received10.1%
Prompt Pay; Timely Filing Deficiency | Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Information Furnished10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Information Furnished; Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Additional Payment Expected; Informati10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer; Usual And Customary | Corrective Action Taken; Contract Langua10.1%
Prompt Pay; SB418 Rule Violation; Unsatisfactory Settle/Offer | Stat Pen Pd-Over 90 Dys Late; Additional Monies Received10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Payment Expected; Contract Language/Legal Issue; Correctiv10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Monies Received; Company Position Upheld10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Monies Received; No Jurisdiction; Company Position Upheld10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Company Position Upheld; Corrective Action Taken10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Payment Expected; Contract Language/Legal Issue; Informati10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Additional Payment Expected; Contract Language/Legal Issue; Insuffici10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Claim Settled10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Company Position Upheld10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Company Position Upheld10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; Additional Monies Received10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Monies Received10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Corrective Action Taken; Contract Language/Legal Issue10.1%
Recoupment Of Claims Payment | Additional Monies Received; Corrective Action Taken10.1%
Overcharges | No Jurisdiction10.1%
SB418 Rule Violation; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Unsatisfactory Settle/Offer | Information Furnished; Company Position Upheld10.1%
Closed-Lack Of Info Cmplainant; Unsatisfactory Settle/Offer | Additional Monies Received; Insufficient Information; Info10.1%
PPACA-Out-Of-Ntwk Emerg Care; Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Contract Languag10.1%
Unsatisfactory Settle/Offer | Mediation Not Eligible; Contract Language/Legal Issue10.1%
Usual And Customary | Contract Language/Legal Issue; Information Furnished10.1%
Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language/Legal Issue10.1%
Material Change To Contract; Not Within TDI Jurisdiction; Other | No Jurisdiction10.1%
Cust Service Claim Handling | Information Furnished; Corrective Action Taken10.1%
Cust Service Claim Handling; Disclosure Of Benefits | Information Furnished10.1%
Other | Information Furnished; No Jurisdiction10.1%
Cust Service Claim Handling | No Jurisdiction; Information Furnished10.1%
Other | Corrective Action Taken; Additional Monies Received10.1%
Cust Service Claim Handling; Enrllmt/Canc/Rnwl Of Enrollee | Information Furnished10.1%
Disclosure Of Benefits; Other | Corrective Action Taken; Information Furnished10.1%
Prohibited PHI Disclosure | Information Furnished10.1%
Unsatisfactory Settle/Offer | Additional Payment Expected; Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer | No Jurisdiction; Information Furnished10.1%
Den/N-Pymt MD Nec DME/Supplies | Information Furnished; No Jurisdiction10.1%
Disclosure Of Benefits; Material Change To Contract | Contract Language/Legal Issue; Corrective Action Taken; Informatio10.1%
Claims Reimb/Bal Bill Problems; Enrllmt/Canc/Rnwl Of Enrollee | Additional Payment Expected; Information Furnished10.1%
Other | Question of Fact10.1%
Den/N-Pymt MD Nec DME/Supplies; Den/N-Pymt MD Nec RX | Information Furnished; Contract Language/Legal Issue10.1%
Recoupment Of Claims Payment | Information Furnished; Contract Language/Legal Issue10.1%
Hlth Care Svcs Covg/Copay/Lmts; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer | Referred for Disciplinary Actn10.1%
Overcharges; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished10.1%
Claims Reimb/Bal Bill Problems; Cust Service Claim Handling | No Jurisdiction10.1%
Overcharges; Unsatisfactory Settle/Offer | Information Furnished10.1%
COBRA; Grp Conversion/Continuation | Information Furnished10.1%
Unsatisfactory Settle/Offer | Clean Claims Violation; Additional Monies Received10.1%
Access to Care | Information Furnished10.1%
Unsatisfactory Settle/Offer | Additional Monies Received; Information Furnished10.1%
Misrepresentation | Information Furnished10.1%
Agent Handling | Company Position Upheld10.1%
Agent Handling; Misrepresentation; Other | Information Furnished10.1%
Unsatisfactory Settle/Offer | Additional Monies Received; Contract Language/Legal Issue10.1%
Not Within TDI Jurisdiction | Information Furnished; No Jurisdiction10.1%
Hlth Care Svcs Covg/Copay/Lmts | Information Furnished; Contract Language/Legal Issue10.1%
Access to Care; Other; Out Of Ntwk Referral | Information Furnished10.1%
Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken; Additional Monies Received10.1%
Cust Service Claim Handling; Overcharges | Information Furnished; Corrective Action Taken10.1%
Unsatisfactory Settle/Offer10.1%

health Complaints by State

StateComplaints
Texas1,273

Recent health Complaints Against SCOTT AND WHITE HEALTH PLAN

Frequently Asked Questions

How many health complaints does SCOTT AND WHITE HEALTH PLAN have?

SCOTT AND WHITE HEALTH PLAN has 1273 health insurance complaints on file, according to NAIC and state DOI data.

What are the most common health complaint issues with SCOTT AND WHITE HEALTH PLAN?

The most common health complaint issues for SCOTT AND WHITE HEALTH PLAN are: Claim denial (469), Delayed payment (306), Premium or billing dispute (124), Usual And Customary | Contract Language/Legal Issue (27), Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue (27).

Which states have the most health complaints against SCOTT AND WHITE HEALTH PLAN?

The states with the most health complaints against SCOTT AND WHITE HEALTH PLAN are: Texas (1273).

health Complaints by State

SCOTT AND WHITE HEALTH PLAN Complaints by State

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