Encompass prepares complaint against Blue Cross

By Claudia Balthazar | Sep 5, 2016

McKINNEY, Texas (Southeast Texas Record Weekly) – Encompass Office Solutions Inc. has formed a complaint against Blue Cross Blue Shield after the insurance company allegedly cheated Encompass out of future revenue, and then declared a new trial when a jury found Blue Shield guilty in the case

Following the verdict, Blue Cross owed Encompass $26 million in a contract law suit even though the company was first cleared of the breach of contract in October 2014. U.S. District Judge Jorge A. Solis saw that Encompass was held at an unfair standard and re-examined the case, making Blue Cross pay for the $25 million in future revenue that it cost Encompass.


Encompass is filing a complaint after Blue Cross failed to pay $1.4 million in claims and used its influence to rob the surgical company of future business.


A new case dismissed the jury’s “take-nothing decision” after finding that Blue Cross sent a letter, which told doctors to refuse Encompass’ services. The letter had threatened to fire doctors who were caught using any of Encompass’ drugs, equipment, supplies or nurses. Such a letter proved to be damaging to Encompass since its business thrives off providing those services to doctors performing in-office surgeries.


The judge said Encompass was held to an unfair standard in the initial processing of the case because the jury was given wrong instruction.


Encompass alleges that Blue Cross had not gotten in the way with its services, it would have been a “win-win-win” situation for the patient, physician and insurance company. The company says Blue Cross should have embraced its services being that it ensures safety and saves insurance companies money over other services like it.


Patients in Texas and the surrounding states would be deprived of excellent services and high-quality care should Blue Cross continue with its letters telling doctors to not use Encompass, according the plaintiff’s complaints. One patient described Encompass’ services as “life-saving.”


The case says Blue Cross was “arbitrary and capricious” when it sent letters to doctors, threatening to fire them should they use Encompass’ services.


Yet, Blue Cross alleges Encompass was past its one-year statute of limitation for making allegations against the insurance company. Encompass still asked for a new trial and demanded the statute of limitation be dismissed until it is clear that the claims against them made by Blue Cross in the letter were false.


“As the court has repeatedly held, knowledge [or an unreasonable lack of knowledge] of falsity is what was necessary for Encompass to be aware of its cause of action,” Encompass said. “As the jury found, Encompass did not acquire or have an opportunity to acquire the knowledge until February 2013; therefore, its claims are timely because the statute of limitations was tolled in the interim.”


The letter told doctors that they should not use Encompass’ services because it is considered an out-of-network provider and that the fees are not covered by the insurer. However, Encompass says that was not true prior to 2013, while the letter was written in August 2010.



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Blue Cross Blue Shield Texas Encompass

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