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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Screwed Me Over
Posted by ToniD on 05/27/2009
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.