To say that Americans don’t like their health insurance companies may be putting it mildly. In a recent survey asking consumers to rank their satisfaction with companies across 43 industries, health insurers placed in the bottom five, ahead of only Internet service providers, cable companies, the U.S. Postal Service and fixed-line telephone services. Even banks received higher marks from consumers.

Those findings, from a survey released on Tuesday by the American Consumer Satisfaction Index, aren’t all that surprising, says David VanAmburg, the managing director of ACSI. (The ACSI surveyed 70,000 customers to get their opinion on everything from athletic shoes to hotels.)

Related: Americans Give Health Insurers a Big Thumbs Down

Health insurance is complex and hard to understand, even compared to other forms of insurance, like life insurance. The number of plans offered can be confusing to consumers, as the ACSI survey found, and the rising cost of premiums, deductibles and copays is often frustrating. Also, calling health insurers is typically a hassle — their call centers received the lowest rating out of all customer experience measures in the survey.

VanAmburg adds that the heightened frequency with which people engage with health insurance companies compared to other insurers is also a factor.

Yet even within the health insurance industry, some companies fare worse than others. The survey found that people dislike bigger insurance companies much more than the smaller ones, which have fewer customers and as a result may be able to provide better customer service.

Related: Americans Rank Health Care as Top Financial Burden

The lowest of the low was Cigna, which scored a 60 out of 100 in the customer satisfaction index, which Forrest Morgeson III, ASCI’s director of research, describes as “quite low.”

“This is not only the lowest in this particular industry, but it is low compared to other poor-performing ACSI companies and industries,” Morgeson wrote in an email. “This is worse than some of the large cable companies (like Charter, which scores 63), and they tend to get very, very low scores.”

Cigna’s score soon drop even lower thanks to its upcoming merger with Anthem. Mergers, particularly in the service sector, typically go badly because the companies have to combine operations, which often causes some hiccups. “History doesn’t suggest this will go well,” VanAmburg says.

Below are the 2015 rankings of the largest health insurance companies from highest to lowest customer satisfaction, with their index score according to the new ACSI data:

8. Smaller Insurance Companies (71)

7. Humana (71)

6. Kaiser Permanente (71)

5. Blue Cross and Blue Shield (70)

4. Anthem (69)

3. Aetna (68)

2. UnitedHealth (66)

1. Cigna (60)