Encompass Insurance Complaint - Encompass Ripped Me Off!
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.