The Corner Penthouse

This is the latest in a series of articles about the dental hassles that I have had to go through due to being poor, and thus not being able to afford proper dental insurance. It was never meant to be a series of articles, but I have had to endure so much bullshit, which I felt needed to be documented, that it's now become an ongoing series. I really hope that at some point an insurance company and dentist will take pity on me and finally put me in a situation where I'll be set for life and I won't have to continue dealing with this over and over again. Read on to find out more...

Let me start by stating everything that has happened that got me to this point.

• FROM CIRCA 1995 TO PRESENT - I have had at least TWO DOZEN different dentists (some listed in my 2021 article), across residences in two different towns, because I have state-provided Medicaid insurance. The routine would be: I would find a local dentist, in walking distance, that accepts Medicaid. I would start going there and things would be fine. Then after (usually) two years, the dentist would decide to STOP accepting Medicaid, and call me up the day before my scheduled appointment to tell me. Rather than continuing to accept Medicaid for all pre-existing patents, the dentist would just put his profits ahead of his patients and kick them to the curb. I would then have to start the routine all over again. (I have heard that most dentists don't want to accept Medicaid because they're slow to pay out. I think it's really because accepting Medicaid means that the dentist has to accept a pre-set price for work, so he can't overcharge with his own prices. The easy fix is for the U.S. government to force dentists to accept Medicaid as a requirement for getting a medical license.)
  
  
• JULY 2021 - The last dentist I saw while I only had Medicaid insurance was in the Summer of 2021. The dentist wanted to fill some teeth, but due to my anxiety and sensitive gag reflex, the work could not be done. This dentist did not provide Nitrous Oxide gas, or any form of stronger sedation. I went for a year and four months with unfilled cavities because there were no local dentists that accepted Medicaid and provided gas. Actually, there was one: a pediatric dentist who refuses to see adult patients, which seems like discrimination to me. I'm pretty sure that's illegal.
  
  
• SEPTEMBER 2021 - Realizing that I needed better insurance than straight Medicaid, but not having the money to pay for better insurance, I figured that my only option was to sign up for one of those Dual Eligible Special Needs Plans (D-SNPs) for individuals with both Medicare and Medicaid that I constantly see advertised on TV. After conferring with all of my doctors, I settled on Aetna, and became a member as of October 1, 2022.
  
  
• OCTOBER 2022 TO DECEMBER 2024 - Aetna provided the dental insurance themselves, which gave me a $2,000 yearly allowance for almost all procedures, except cosmetic. After a rough start with some disreputable dentists in town, Marilyn Gaughan (from Aetna's Medicare Executive Resolution Team) got me set up with The Smilist. I started going there in March 2023, and although the front desk receptionists kept insisting they didn't accept my Aetna dental insurance EVERY TIME I WENT THERE IN 2023, Aetna paid for all of the work without issue. The Smilist also did the Nitrous Oxide gas, so the situation was perfect.
  
  
• NOVEMBER 2024 - Aetna didn't want me to finally have a perfect dental situation after 30 years of cycling through dentists. In a move that I'm sure the Aetna execs did because it saves them money - while they still earn their executive bonuses and pay raises - Aetna decided that starting in 2025, they would no longer provide me with Aetna dental insurance! Instead, they would force me to use an unknown no-name (to me) third-party known as Liberty Dental Plan for all of their members dental insurance. To make matters worse, Aetna failed to properly notify their members of this BIG FUCKING CHANGE. I only found about it when I received my 2025 Aetna member card and noticed that in the upper right corner it now said "Liberty Dental". Immediately, I got in touch with Marilyn Gaughan to voice my concerns. After all, she found me The Smilist, and got me into a good situation. As expected, she reported back that The Smilist was not in-network with Liberty. Yes, for the first time, it wasn't the dentist that dropped my insurance, it was my insurance that dropped the dentist. I asked for Marilyn to get Aetna to give me back the Aetna dental insurance, but of course, a big corporation will not do the right thing for their members. Remember folks, the American Healthcare System puts profits before people.
  
  
• DECEMBER 2024 - Since I wanted to continue seeing The Smilist, and Aetna would not let me, my only option was to find a new insurance company that The Smilist was in-network with, and that all of my doctors would accept. Making matters worse is that I found about Aetna's devious dental plan just a few weeks before the U.S. government's "open enrollment" deadline, and right before Thanksgiving, when agencies are closed for the week. That gave me very little time to find a new company and sign up with them. It seemed that the only company that fit the bill was United Healthcare. As noted in my article, their online dental provider search AND their phone reps BOTH confirmed that The Smilist was in-network with them; with EIGHT dentists at the office listed, no less! Having all of that confirmation, I happily signed up with UHC.
  
  
• JANUARY TO MAY 2025 - I officially became a United Healthcare member on January 1, 2025. There were no issues with my doctors, through the OTC program was a big headache, as noted in this article. The most important matter was the dental. In March 2025, when I went for my scheduled cleaning at The Smilist, I would find out that UNITED HEALTHCARE FUCKING LIED TO ME! The front desk receptionist took one look at my UHC card and said, "We don't accept this." I pulled out a printout from UHC's dental provider search showing the eight dentists, and without even looking at it, she said that none of them were still at the office. I never felt more angry and depressed in my life.
  
  
• MAY 2025 - Since United Healthcare LIED to me about The Smilist, and having other issues with them, I knew I had to leave them IMMEDIATELY! Normally the U.S. government doesn't let its citizens switch insurance providers in the middle of the year; only during an "open enrollment" period that generally runs from mid-October to early December. I suspect that the large insurance companies made the government do this so those companies can wring a year's worth of money out of its members. Thankfully, after informing the government healthcare.gov phone rep that I needed to make the change due to being LIED to by United Healthcare, they made an exception and put me back onto Aetna. Sure, it meant that I wouldn't have any dental insurance - because as previously noted, The Smilist was not in-network with Liberty - but I could not stay with United Healthcare any longer. As of June 1, 2025, I was an Aetna member again.
  
  
• OCTOBER 2025 - On a lark, I decided to check Liberty's dental provider search to see if there were now any in-network options. Imagine my surprise when I saw several dentists at The Smilist that were listed. Having been burned with this before (see UHC), I felt that I should contact Marilyn Gaughan to confirm the information. I sent an e-mail to Marilyn at the MedicareExecutiveResponse@aetna.com address, but instead of Marilyn, it was responded to by Cindi Dorfzaun from the same executive response department. She confirmed that The Smilist "is in-network with Liberty, however, the providers below are no longer with The Smilist. There are now three providers only in the practice: So Park, Valeria Persaud, and Paul Natter." Taking it one step further, I asked Cindi to call The Smilist office and personally confirm with them that they accepted Liberty. As per an October 14, 2025 e-mail from Cindi, "I called an spoke to Debbie. She confirmed you are an established patient, and the claim will be sent and paid for." That was GREAT! I even went in person to The Smilist office and confirmed it with Debbie myself, and gave her a copy of my Aetna member card which states that I have Liberty Dental coverage. I guess sometime in the past 11 months (from December 2024 to October 2025) The Smilist became in-network with Liberty.
  
  
• OCTOBER & NOVEMBER 2025 - I had lots of work done at The Smilist, starting with a cleaning and x-rays. Dentist Anam Khalid found a few cavities that she wanted to fill, one new crown she wanted to put on, and one old crown she wanted to replace. Over the course of several weeks, I had all of the work on the right side of my mouth done, but nothing on the left side of my mouth. This is because in early November, Debbie told me that all of the work done so far totaled $1,932.00 and that my Liberty insurance has a $2,000 yearly allowance. If any of the left-side work were to be done now, I would have to pay for it out of pocket. Obviously, I could not do that, so I made an appointment for early 2026 to have the rest of the work done.

If you're still with me at this point, we have now reached February 2026; the present.

The month didn't start off so well when, on February 2nd, I received this $1,932.00 bill in the mail from The Smilist.


I always find it amusing when doctors send me bills, especially substantially large bills like this, thinking that I have the money to pay them. If a doctor is serious about being paid, do NOT send the bill to me. That only guarantees that it WON'T be paid. It's my insurance companies who have the money to pay my bills, and are responsible for paying them.

Putting aside the pointlessness of sending a bill to me, I think I know what happened, and it's actually Aetna's fault; and only partly The Smilist's fault. You see, the Aetna member card that is also used for dental services DOES NOT HAVE ANY LIBERTY DENTAL INFO ON IT. The front only says "Liberty Dental" in the upper right corner and has no other relevant information. The back has a provider website (aet.na/LibertyDental) and a Dental Customer Service phone number (1-866-610-0282), but no dental plan information. However, the BIG PROBLEM is that it says to "Send claims to: Aetna Medicare, PO Box 981106, El Paso, TX 79998-1106". So, of course, The Smilist figured that they should send the claim to Aetna Medicare.


As was noted in the papers Aetna sent me (one claim example below), all of the claims were "DENIED" with Note #4, which states, "We asked your provider to send this claim to Liberty." Also, for some reason, it lists Dr. Khalid as an "out-of-network provider".


You will notice that document shown above is dated November 13, 2025. At no point in the three months since then did anyone at The Smilist submit the claims to Liberty, as Aetna instructed them to do. Instead, they thought it would be wiser to send the bill to me. Furthermore, it states, "However, you are not responsible for paying the billed amount because you received this service from an VBID DSNP Direct Access HMO - Medicare (Aetna) provider OR based on a referral from an VBID DSNP Direct Access HMO - Medicare (Aetna) provider." I don't know what all of that means, but it clearly says that I am "not responsible for paying the billed amount", so The Smilist should NOT have sent me a bill.

I should also state that after receiving that bill, my first instinct was to contact the high-level Aetna reps, Marilyn and Cindi, to get to the bottom of the matter. Using the MedicareExecutiveResponse@aetna.com address didn't get me either lady. Instead, I was introduced to a new rep: Veronica P. She is the rep currently handling my case. Hopefully she'll be able to get me a resolution that will give me a long-term permanent solution to my dental woes, but my experience has shown me that large corporations, and the people who work for them, don't care about the "little guy".

Anyway, the $1,932 bill for the 2025 work is just the tip of the iceberg of bullshit I have had to deal with this week, and it gets MUCH WORSE...

I went into The Smilist office on Wednesday February 11, 2026 at 11:15 AM for my scheduled appointment with Dr. Khalid to do all of the left-side work that went undone over the past three months. First, I asked Lorena and another woman at the front desk (whose name I forgot to get) if they sent the claims for the 2025 work to Liberty. They said that it was sent the previous Friday, February 6th; the day after I got a call from Danielle in The Smilist's billing department asking me for my Liberty information, such as the group number. (I told Danielle that there isn't any Liberty-specific information on my Aetna card and that she should call Liberty to get whatever information she needs.)

As for the dental work that I was there to have done, they had a treatment plan already printed out and ready for me to sign. I didn't even get to look at it, much less sign it, because they looked at the computer and told me that Liberty will only pay 50% of the work, and that I WOULD HAVE TO PAY $600 OUT OF POCKET! WHAT THE FUCK!!! At the end of 2025, Debbie told me that my Liberty insurance had a $2,000 yearly allowance. That means that I do not have to pay anything out of pocket unless the work goes over $2,000. There was no "Liberty pays half, you pay the other half" bullshit. (NOTE: Based upon what I was later told by Liberty rep Katie, this 50/50 bullshit was not correct. I have no idea why the front desk gatekeepers at The Smilist would give me false information. It's not the first time, sadly.)

It was confirmed by Aetna executive rep Cindy, and myself, in conversations with The Smilist office manager Debbie in October 2025 that The Smilist was in-network with Liberty. As I've always known it, if a provider is in network with an insurance company, it means the work will be 100% paid for because both companies agreed on a set amount to be paid.

Since I could not pay $600, I had to leave the office - dejected and depressed - without having any work done, even though it had been put off for the past three months because Debbie said I had a $2,000 yearly allowance that was to have reset on January 1st. I now believe that Debbie was wrong about Liberty having that allowance, and that she was confusing Liberty for the Aetna dental insurance I had in 2022, 2023, and 2024, which DID have that $2,000 yearly allowance. That's the insurance that I NEED to get back, but I doubt Aetna will give it back to me.

Who knows what, if anything, Liberty will pay of the $1,932 for the 2025 work that I had done under the false pretense of having insurance with a $2,000 yearly allowance.

As soon as I got home, I called Aetna executive rep Veronica P. at 12:35 PM. She pulled up my 2026 Evidence of Coverage, but without having any procedure codes from the dental provider, she couldn't give me much information. She did find out that crowns are covered when medically necessary and require pre-authorization. Eventually, she transferred me to Katie at Liberty's customer service line (1-866-610-0282). Katie said that my benefit will pay for crowns, fillings, and gas. She also said that I do NOT have out-of-pocket expenses (phone recording snippet below), but that there are limitations.


Oh, boy are there limitations! Again, below is the relevant snippet of the phone conversation, though I have also listed the limitations below in case you don't want to spend 7-minutes listening to the audio.


Here are the FUCKING INSANE LIMITATIONS Katie told me that are imposed by Liberty Dental:

• FILLINGS - One per tooth in my lifetime!
• REPAIR FILLINGS - One per tooth every 60 months (aka FIVE YEARS)!
• CROWNS - One per tooth every 60 months (aka FIVE YEARS)!
• NITROUS OXIDE GAS - Requires pre-authorization and only for 60 minutes.
• TOOTH EXTRACTIONS - Covered with NO limitations.

Of course they will pay to have teeth extracted, but not for ongoing life-long work to keep the teeth.

I just, begrudgingly, created an account on Liberty's website so that I could see the entire Summary of Benefits pdf document. It's a SIX-PAGE TINY-TEXT HORIZONTAL CHART that lists every excuse Liberty could come up with for why they will NOT pay for this and that. (Below is just a small snippet of one page as an example.) After looking at that, it doesn't look like there is anything that Liberty WILL pay for. I guess that's how Liberty saves money. Another example of what is wrong with the American Healthcare System.


After speaking to the Liberty rep, and realizing that they probably won't pay for any of the work that is left to do, much less anything in the future, I felt like I should make The Smilist aware of just how dire my situation is. Not just because I don't want them to send me any more bills, but also because I would like to finally have a permanent dentist for the rest of my life. Rather than dealing with anyone at the front desk, I felt it would be best to speak to the dentist herself. On February 11th at 3:06 PM, I received a call back from Dr. Anam Khalid. First, I told her that I couldn't be seen today due to Lorena (and the other lady) saying that Liberty would only pay 50% of the work and that I'd have to pay $600 for the other half. I told her about Liberty's insane limitations, which makes it seem like none of the work will be paid for. To find out for sure, I asked her to submit today's treatment plan to Liberty for pre-authorization to find out what they would pay. Khalid said that she would tell them at the front desk to do this.

I really wanted her to understand that I am a very-low-income individual with one fixed-income check a month, which isn't even enough to pay the rent on the place where I'm living. I had to get someone to move in after my parents died so that I wouldn't be homeless. I am hoping that she, and the other staff at The Smilist, will take pity on me and be willing to make considerations for me so that I can continue going there for the rest of my life. I can't keep looking for a new dentist every two or three years. I've run out of dentists.

(1) One consideration they could make would be to use my secondary insurance (Medicaid) to pay for what Liberty doesn't, as all of my other doctors do. I know that dentists don't like accepting/using Medicaid, because they're either slow to pay or forces the dentist to accept a lesser amount, but I am hoping that Dr. Khalid and The Smilist won't be like the other greedy dentists. (2) Another consideration would be to write off what Liberty doesn't pay for as "charity work". Yes, I realize that's a big "ask", but hopefully Liberty would pay enough that they would still get enough money for the work.

The worst case scenario is that since Liberty will pay for tooth extractions with no restrictions, anytime a tooth needs to be filled or have a crown put on it, the tooth will just be removed, instead. Hopefully this won't happen enough times that I will have no teeth left.

Dr. Khalid seemed somewhat sympathetic to my plight. She said that she will send an e-mail to Debbie (the office manager) to try to get this straightened out and that they will be in touch.

I'm hoping for the best, but expecting the worse. It seems that the Liberty Dental Plan isn't insurance, only the pretense of being insurance.