Encompass Insurance

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Encompass Ripped Me Off!
Posted by on
I want to alert people about Encompass Insurance and their unfair and deceptive practices. A guy t-boned my car several months ago (he got a ticket) and I had several injuries. I had neck, rib, and thoracic sprains, as well as a dislocated sacrum (where the spine attaches to the pelvis). I also had muscle spasms (like cramps). Basically, my whole spine and back was involved to a degree.

I was told by Encompass to use the Medical Expense (Med-Pay) coverage I had in the policy. I was told when I bought the policy that the coverage was non-specific--I could use it for whatever treatments I needed, even to cover my health insurance deductible. The Encompass adjustor also told me that they didn't require specific types of providers or care, that the choice of treatments was up to me and my providers. I now know that's BS, and that they are deceptive in their selling and case management!

After several months of treatment, they cut off coverage before I was healed and before I had reached the coverage limit. They had a "Peer Review" done by someone I never met or talked to, a Mr. Juan De La Vara. This person alleged that mistakes were made in the early medical codes some providers used. He also claimed more documentation should have been provided early on. After investigating his claims, I find they are quite false! The proper documentation was sent, and it is Mr. De La Vara who is uninformed about medical coding. In general, he was mis-applying Medicare codes to my case, but this is not a Medicare claim! The Physical Therapy said it is Mr. De La Vara that doesn't know about the proper use of medical coding!

Encompass paid those bills months ago, having no problems with the documentation or coding when they came in. The paid them in full, with no overcharges indicated. What's more ridiculous is that Encompass said they would audit the bills as they came in and would check for problems or possible over charges.

Encompass used this false and dishonest document to cut off coverage, which is really cruel and makes no rational sense. People have told me that these Peer Reviews are designed to favor the insurance company because they pay for the review. They look for any possible problems, real or imagined. Then they exaggerate those alleged problems as much as possible to phony up a case to end coverage. But the degree of dishonesty here is astounding! For Encompass to use this review by Mr. De La Vera is a reflection on the dishonest way they conduct business. They need to be exposed!

In addition, Mr. De La Vera never included my diagnosis or pain levels in his review, never talked to me or my providers to clarify any questions, never did an exam, and even left out the improvements I have been making. How sick can someone be to create such a distorted picture and sell out to an insurance company? Encompass was all too quick to use this dishonest review to cut off my coverage!

I can not recommend Encompass Insurance their adjustor, Ray Rhodes, or the agency that sold the policy, Hilb Rogal & Hobbs (HRH) of Denver.
     
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Timboss on 06/27/2006:
Time to see a lawyer.
Doc J on 06/27/2006:
Is your insurer subrogating the claim and going after the at-fault driver? I can understand using the medical payments portion of the policy to pick up amounts unpaid by the at-fault driver or as "gap" insurance until the at-fault claim is resolved. The provider's claims may have been properly coded and can still be properly rejected. Virtually all insurers use the same ICD-9, CPT, and HCPC codes. However, read the "how claims are paid" portion of the policy. Some insurers use "Medicare-based exclusions and qualifiers" to determine payment eligibility (MCB guidelines are pretty restrictive and some insurers use their criteria rather than having to write their own). I have a feeling this may have happened here. Finally, rejected claims due to poor documentation are the burden of the provider. If a claim was rejected because of inadequate documentation by the provider, the provider is obligated to correct the problem. Otherwise, poor documentation becomes a mechanism to avoid dealing with insurance and billing the patient directly. You need personal attention by your insurance agent and a lawyer because you need better/more-detailed advice than can be found on the Web. Good luck!
Doc J on 06/27/2006:
One other point...that the claims were accepted months ago and were later rejected is understandable. Encompass likely did a "post-payment review" (audit) of the provider claims. And yes, these reviews almost always favor the insurance company. I hope your provider(s) is (are) being your advocate in this matter, rather than just being emotionally supportive.
scarny on 06/29/2006:
I just found out that Encompass is a division of Allstate, a company with a reputation of doing this kind of thing. I thought they were still part of CNA. No wonder. In fact, check out this site on bad faith insurance companies:

http://www.badfaithinsurance.org/indexdetaillist.html

Allstate is number 3, and the footnote shows Encompass as one of their divisions. If only I knew that CNA no longer owned them!
scarny on 07/14/2006:
I just wanted to reiterate for those that missed it that the peer review was fabricated and largely false. The proper documentation was provided to the insurance company and the alleged billing errors were incorrectly based on Medicare codes. The correct codes were provided--this was not a Medicare claim! The insurance company did not overpay!
scarny on 07/15/2006:
Although it was a tedious amount of work, I have uncovered even more dishonest and false information in the peer review that Encompass used to cut off my Med Pay coverage!

Juan De La Vara, who created this dishonest and fraudulent review can't count! He alleged that I wasn't improving and was seeing my chiropractor every 3 days over a 6-week period. Not true! My billing copies from that period (the same ones the insurance company has) show significantly longer times between visits and relative improvement over the frequency of visits I had.

The treatment dates represent a significant lessening of treatment frequency. They show improvement, contrary to De La Vara's false statements. And I continue to improve under the very care De La Vara said was unnecessary, no thanks to Encompass and the terrible stress they have dumped on me. The only fraud and corruption here comes from De La Vara and Encompass. This type of peer review should be illegal and the division of insurance should push for that. From this day forward, I promise to expose the dishonest, corrupt, and fraudulent activities I have encountered, including the HRH Insurance agency, Encompass, and their employees.

Unless you want to be mistreated and abused, do not buy Encompass Insurance. Their slogan should be, "Your bad-faith insurance company!"
scarny on 08/01/2006:
I filed a complaint with the state. Encompass responded, after many weeks, with more spin and lies. Actually, they glossed over most of my complaint, and didn’t even answer all of the questions the state asked them!

Their cheer must be, “Lets keep the fraud going!” They have demonstrated a profound lack of integrity with every opportunity. They’re part of Allstate, one of the most complained about companies in the US. Check out the FBIC website for companies that act in good faith. Here is a link: http://www.badfaithinsurance.org/indexdetaillist.html

Good luck and choose wisely!
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Claim Denied
Posted by on
Rating: 1/51
WILMINGTON, NORTH CAROLINA -- I was making a left turn and a young guy passed me in the left lane. It was only a two lane highway right after a stop light. I had my signal light on to turn left and he passed as I was turned and I hit him on the passenger side. He received a ticket from the state patrol officer (NC). The insurance adjuster, Ann Kuhn, told me that I should be able to go ahead and get the rental car and she would get it put through as soon as possible. The next day I called her and she told me that her supervisor had rejected the claim and they would not pay anything. The towing was $185, the rental was $73, and to get the car towed to my home was another $44. They stated that when the driver is at fault at any percentage they can reject the claim. They admitted the young guy was at fault practically 95% but they said because I could have avoided the accident, they would not cover the claim. This is bull. I would not ever use this insurance company. They are thieves and liars. May God rain down on them.
     
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Encompass Insurance Driver Ticketed for Auto Accident but They Deny Claim!
Posted on
Rating: 1/51
Police report narrative(EXACTLY how it is in the police report(names removed):

driver#2(me) told me that he was NB on 35th ave SW in the curb lane when vehicle #1 put on her turn signal and moved into his lane causing him to swerve to get out of the way. This action forced him into striking vehicle #3 (legally parked). Driver#1(her) told me that she put on her turn signal and began to change lanes when she saw that #2 was in the curb lane and moved back into her own lane. #1 was NB in the inside lane at the time. #2(me) told me that he was just behind #1 putting him in her blind spot. #1 was cited for an unsafe lane change..."

On 8/21/2014 Encompass claims adjuster Andy [Snip] called me at 10:30 am and denied the claim stating to me on the phone "You made an unsafe swerve" so we are denying liability.
     
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Screwed Me Over
Posted by on
I was in an accident last month and the guy that hit me and totaled my car didn't have enough insurance to cover the cost of replacing it. So good thing I had underinsured motorist, well if you want to call it that. The woman that I had to deal with from Encompass, Trinka M, was so rude and insensitive to me. She tried telling me they don't have to give me the value of my car, they only have to give me what it would cost to buy it from a private seller. First of all my car is rare, they only made it for 2 years and I only found one for sale in my state. I would have been happy if she had just given me that value, but no she drew this process out and I still don't have a check and I had to return my rental 2 weeks ago. They wouldn't give me credit for things that I had on the car that increased the value. My husband had to go to the lot where it is waiting to be auctioned off and remove everything. This company if all fine until you file a claim oh of course accept for the fact that they are not there 24 hours a day and if you call they will take 2-3 days to call you back.

I understand, these people are trained to get the victim to accept the Lowest amount possible, but this woman was just plain mean and rude. She never once asked if we were OK or ever said have a nice day.

Encompass is terrible to their customers and they can thank Trinka M. for me canceling my insurance and they can be sure I will be telling everyone that wants to listen.
     
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madconsumer on 05/27/2009:
if your vehicle is so rare, why didn't you make sure to have enough coverage?

"She tried telling me they don't have to give me the value of my car, they only have to give me what it would cost to buy it from a private seller."

correct and or to repair it. this is why they have gap coverage. sounds like you took the low cost road and did not have gap coverage, and you lost.
Slimjim on 05/27/2009:
It's a tough call. If you had it appraised, then the would have to repair it to specs of give you appraised amount. If you want to get legal, you cam have an attorney submit a book value figure as a demand. Another recourse, you can sue the person that hit you for the gap.
Anonymous on 05/27/2009:
mad, They have gap insurance to pay the difference between the actual cash value of a covered vehicle and the current outstanding loan balance. Gap insurance isn't applicable here because there was no mention of an auto loan or that the adjusters amount was less than the auto loan.

jktshff1 on 05/27/2009:
special insurance is available. You should have had it.
That is why working through a local agent is important, instead of these "let us insure your car cheap" places.
My lawyer, dr, dentist, and insurance agent are all younger than me and I've been with them for over 35 yrs. They have been good to me.
I'm going to die before they do so I won't have to look for another one.
madconsumer on 05/27/2009:
okay crabby, I'll give you this one, this ONE, not two.
ToniD on 05/27/2009:
I didn't know my car was rare until I had to replace it and I did use a local agent. I owe less than what they are trying to give me, but my point is: The people that I had to deal with were insensitive jerks and I don't want anyone else to have to deal with these people. Find insurance elsewhere!
jktshff1 on 05/27/2009:
Then that is your fault, not the insurance companies'. Good information (voted helpful). Apparently, from your reply, the insurance company did uphold their end of the bargain, since you have a payoff. A good agent would have informed you of the additional value and sold you a more expensive policy to cover it. The agent is your problem, not the company.
ToniD on 05/28/2009:
How did they hold up their end of the bargain? They short changed me by $2000 from the comparable I found and showed them. They used dealer vehicles from a different state to get the value, then told me they won't give me those values because they only have to replace it based on a private sellers price. I don't believe this has anything to do with my local agent. This has to do with the way I was treated through the entire process by one nasty adjuster.

And actually, I don't have a payoff. It' been over a month and I still don't have a check nor have I gotten a phone call in 3 weeks. I call every week to find out the status, which I shouldn't have to do, and I don't get a phone call back.
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