The Corner Penthouse

I've already written about all of the dental woes I've had because dentists will usually stop accepting my insurance (Medicaid) after a few years, and then I'd have to find a new dentist. The latest variation on that was last year, when the insurance company (Aetna) forced a change in dental plan to one that my dentist did not accept. Due to that, I left Aetna and signed up for United Healthcare. Well, United Healthcare deceived me when I signed up last December with an outdated dental provider search - and representatives who lied to me - so that it seemed like my dentist accepted my soon-to-be plan, when they didn't. Let's take a look at how I'm getting screwed over yet again...

As of January 1st, I have been a member of United Healthcare (UHC) with one of their Dual Complete plans for people who have both U.S. Medicare and N.Y. Medicaid (aka "poor people's insurance"). When I called up in early December to sign up with United Healthcare, the representative confirmed that my current dentist (The Smilist at 17 West Merrick Road in Valley Stream, NY) accepted this plan. As seen in the screenshot below, I even found EIGHT dentists at The Smilist listed on the UHC dental search website at UHCMedicareDentistSearch.com, which was linked to on the United Healthcare webpage for my soon-to-be new plan. (On the aforementioned Dentist Search website, check "National Unitedhealthcare Dual Complete Network", select Location, then enter "17 West Merrick Road, Valley Stream, NY 11580".) So, with confirmation from the UHC rep, as well as eight dentists listed in the online provider search, I had no reason for concern. I happily signed up for United Healthcare without giving it a second thought.


I went to The Smilist's Valley Stream, NY office today, March 12, 2025 at 12:00pm, for my scheduled cleaning appointment. I gave the front desk employee my new United Healthcare card. She took one look at it and said, "We don't accept this". I told her that according to the United Healthcare (UHC) dental providers website, there are EIGHT dentists in this office that accept my plan. I pulled out a print-out to show her, but WITHOUT EVEN LOOKING AT THE LIST, she said that all of them are no longer with the Valley Stream office. I find it hard to believe that Paul Lanza, Sarah Dienstag, Yigit Gol, So Eun Park, Maxime Gregoire, Grace Oconnor, Neha Khan, and Paul Natter are ALL no longer with the Valley Stream office. Is the Valley Stream office *THAT* bad that EIGHT dentists all left en masse?!?

Of course, as I look at The Smilist's own website, I see that SHE WAS FLAT-OUT LYING TO MY FACE! Yigit Gol, So Eun Park, Neha Khan, and Paul Natter are ALL listed on The Smilist's website, on two different pages!


Of course, just because she lied about the dentists, doesn't mean that she was lying about The Smilist not accepting my UHC plan. I now believe that the UHC dental search website at UHCMedicareDentistSearch.com (which redirects to https://dentalsearch.yourdentalplan.com/providersearch - but I can't link directly to that page) is OUTDATED! That it even lists four dentists that aren't at The Smilist's Valley Stream office anymore tells me that it's an outdated site. Yet, UHC is STILL linking to this outdated provider search on the page for my plan, and possibly other plans. UHC already deceived me into signing up for their plan because of this back in December 2024. That UHC hasn't taken this outdated search down means that they are continuing to deceive people. That is not right.

UHC doesn't make it easy to find the real up-to-date Dental Provider search. When you log into your account on the UHC website, if you click on "Find Care" from the top navigator bar, and then select "Dental Care", you will be taken to a page on which you will see the message: "Dental provider search is not available online. Call the number on your member ID card to find an in-network dental provider." Talk about absolutely useless.


I did call up two different UHC phone lines, both of which are listed on the back of my member card: the Main Member Line at 1-800-514-4912 and the "UHC Dental Customer Service Line" at 1-844-275-8750. (The latter is really meant for dental professionals to call, but if you press "0" when prompted for Tax ID and MPI numbers, you can talk to a representative.) I made two calls to the Dental line and one to the Member line. One of the Dental reps found Sarah Dienstag at The Smilist in her dental provider search for my plan, which I already know is incorrect. Geez, you'd think the UHC Dental reps would have an up-to-date search to work with. The other Dental rep wasn't much better, having sent me a list of dentists in my area; except he thought "my area" was MICHIGAN! Surprisingly, the Member rep is the one to have done the best job with a dental provider search. The search she was using actually seemed to be the real up-to-date Dental Provider search. The good news, is that I actually found where UHC hid it!

While this should be listed on the member site, instead of the incorrect "dental provider search is not available online" message, you actually need to go to the Member Login page at member.uhc.com/myuhc - but DON'T LOG-IN! Instead, look for the "Find A Dentist" link (toothbrush icon) in the middle of the page. It points to the WeRally site (https://connect.werally.com/plan/uhc/375) but you can't access that page directly, as it wants a referrer from UHC.com in order to allow access. I found this UHC Member Login page because it is a redirect from YourDentalPlan.com, which was the return address on the list of Michigan dentists I got from one of the UHC reps. So, at least that e-mail wasn't entirely useless :-)

The real, current UHC dentist search only shows five dentists in Valley Stream - and they all seem to be the same ones that I would have been forced to go to if I stuck with Aetna and the Liberty Dental Plan they started using in 2025. I called and researched all of these dentists, and many more, back in 2022. The only one that provides gas is a pediatric dentist. I actually went in there back in 2022 (when I had straight Medicaid) to see if they would be willing to see me, as an individual with special dental needs. They would not; they only see children. I feel like that's age discrimination.

I had to do an awful lot of detective work in order to find UHC's UP-TO-DATE Dental Provider search. No UHC member should have to go through this. The older 65+ crowd that plans like mine are usually targeted to wouldn't even be tech savvy enough to figure this out. This WeRally.com dental provider search should have been easily available from the member site instead of that stupid message. I can not stress that enough.

Anyway, because United Healthcare is fucking me over by preventing me from continuing to be seen at The Smilist - you know, the dental office that I signed up with UHC specifically so that I could continue going to - I have to, for the MILLIONTH time in the past 30 years, find another new dentist. Specifically, I have the burden of trying to find the impossible: a dentist in walking distance that accepts my UHC plan and provides Nitrous Oxide gas.

The kick-in-the-ass about this whole thing is that the reason I switched from straight Medicaid to Aetna, and then to UHC, is for the dental. Back in 2022, there were NO dentists in Valley Stream that accepted straight Medicaid. At the time, I had cavities that needed to be filled for OVER A YEAR, but the dentist in the next town could not do the work because of my anxiety and sensitive gag reflex; and they didn't provide gas. I thought that if I signed up with a "name brand" insurance company, all of my dental woes would be over. That I would be able to see nearly any dentist in the area. Now with UHC, I'm almost as badly off as when I was on straight Medicaid. It seems like there was no benefit to leaving Aetna, and both dental plans seem to have the same dental providers in their networks.

[UPDATE - 3/26/2025]
After this article was originally published, I noticed that on pages 96&97 of the Evidence of Coverage 2025 document for the UHC Dual Complete NY-S002 (HMO-POS D-SNP) plan, it states that "this dental plan offers both in-network and out-of-network dental coverage, and all covered services have $0 copayment. Out-of-network dentists are not contracted to accept plan payment as payment in full, so they might charge you for more than what the plan pays, even for services that have $0 copayment. Benefits received out-of-network are subject to any in-network benefit limitations and/or exclusions." It also states that my dental plan is POS, which doesn't mean "Piece of Shit" (although...), but actually "Point of Service". Page 204 defines a Point of Service (POS) Plan as such: "As a member of this Point of Service (POS) plan you may receive covered services from network providers. You may also receive covered routine dental services from providers who are not contracted with UnitedHealthcare."

Although I could not find an in-network dentist here in Valley Stream that accepts this UHC plan and does Nitrous Oxide gas, I did find an out-of-network dentist that meets my special dental needs. On March 17th, I made to calls to the UHC Dental Line and the Main Member Line to confirm that UHC would pay an out-of-network dentist for a basic cleaning, and how much UHC would pay. I spoke to Chelsea at the Dental line, who confirmed that my plan has out-of-network coverage and said that my plan WOULD PAY 100% FOR A BASIC CLEANING. Excellent! Right afterward, I called the Member line and spoke to Marco. He kept saying that my plan did NOT have out-of-network coverage, and kept reiterating that it was a HMO plan. I kept trying to tell him that the Evidence of Coverage document, which is the "Bible" for the plan, clearly says otherwise; and that according to that document, the dental part of my plan is POS (Point of Service), not HMO. Not matter how many times I tried to correct him, Marco refused to realize that he was wrong. Seeing that I was getting nowhere with him, I hung up. It's really sad when members know more than UHC reps.

On March 17th, I went to Henner Dental Associates (247 Rockaway Avenue in Valley Stream) for a basic cleaning, which Henner charges $175 for. If UHC Dental rep Chelsea, whom I spoke to just an hour before going to the appointment, was correct - that UHC would pay 100% for a cleaning at an out-of-network dentist - then I shouldn't have to pay anything.

It awaits to be seen if UHC will pay 100% of the $175, some of the $175, or none of the $175. If UHC pays all of it, then I will go back for X-rays and an exam, and possible fillings with gas - all of which I hope UHC will pay for 100%. If UHC pays some or none of the $175 cleaning, then I will not be able to see Henner regularly. That means that I will have to do the impossible: Find a dentist that accepts this UHC plan, does Nitrous Oxide gas, and is easy for me to walk/travel to.

If UHC pays none of the $175, then I will have to appeal it.

In an effort to get United Healthcare to help me with the situation they put me in, I did the same thing I had to do with Aetna: contact an executive, knowing that instead of hearing back from them personally, I would be put in contact with a high-level support rep. That's certainly better than dealing with low-level reps who don't even know as much as *I* do about my plan!

On March 24th, I sent a detailed e-mail to Tim Noel (timothy_j_noel@uhc.com) and Andrew Witty (andrew.witty@uhg.com), the CEOs of United Healthcare and parent company United Health Group, respectively. The next day, I received a reply from Tischa, the Executive Consultant of the Consumer Affairs department (uhg_consumer_affairs@uhg.com).

Date: Tue, 25 Mar 2025 15:48:26 +0000
Subject: Your Complaint with UHC
From: UHG Consumer Affairs (uhg_consumer_affairs@uhg.com)
To: Paul

Dear Paul,

I am writing today to confirm receipt of your email correspondence you recently sent to Andrew Witty and Tim Noel. Thank you for bringing this issue to our attention. I want to assure you we are researching the details of your inquiry. We will follow-up with an update on 3/26/25 or before if research is completed.

If you have any questions for me in the meantime, you can call me at (800) 842-2656 extension [redacted] .

Sincerely,
Tischa
Executive Consultant, Consumer Affairs

I am very happy to have Tischa helping me with this matter. She even called me today, March 26th, to give phone confirmation that she is going to work with their business partners in the grievance department to help me with this matter. Hopefully, there will be a satisfactory outcome. At this point, I would prefer that UHC pay 100% for the cleaning done at Dr. Marc Henner's office here in Valley Stream on March 17th, and continue to pay 100% for all future routine work at his office; including future cleanings, x-rays, exams, cavities filled (when necessary), and the gas needed to do that procedure. Henner is only a few blocks away from my house, and he does the gas, so he would be the best option for me.

If I can not get the proper dental care that I need under UHC, then as soon as I'm able to disenroll from United Healthcare and sign up with a different insurance company later this year, I am going to do that. Hopefully it won't come to that because I'm just sick and tired of having to keep changing dentists and insurance companies.

[UPDATE - 4/1/2025]
Yesterday, I received a "Payment Requested" e-mail from Henner Dental Associates for $123.


Today, I received a physical claims document from UHC showing that UHC only paid Henner $52 (30%) towards the $175 cleaning (D1110 Prophylaxis) that was done on March 17th.


Although I already stated this in this article, let me reiterate that before I went to the cleaning appointment, I wanted to get assurances that 100% of the cleaning would be paid for by UHC. On March 17th at 9:30am, I called the Dental Provider Line (1-844-275-8750) and spoke to UHC rep Chelsea. She told me, "You're allowed two cleanings every 12 months, and the plan pays 100% of the allowed amount." She did NOT state that "allowed amount" is different from "billed amount". Furthermore, to be completely assured that I wouldn't have to pay anything for the cleaning, I then - TWICE! - asked her to confirm that UHC would pay 100% to an out-of-network dentist for a cleaning. Both times, she responded with, "Correct". (I recorded this conversation as proof; below is the relevant part.)


UHC didn't even pay Henner half of what he charged! I could only imagine how little UHC would pay for whatever Henner overcharges for exams, X-rays, and fillings and gas. I can't afford to pay for any more expensive work because UHC would pay so little for it. If UHC paid 100%, it wouldn't matter to me what Henner charged.

I just e-mailed Tischa, the executive consultant of Consumer Affairs at United Health Group, to see if UHC would pay the remaining amount, and also pay 100% for any future work. If they don't agree to that, I can't continue to see Henner, as I can't afford to pay him every time for what UHC won't pay for.

Remember, I am in this situation because UHC deceived me with an outdated dental provider search (linked to the plan page), and the UHC representatives LIED to me, when I signed up in December 2024 by saying that the dentist I was seeing at the time (The Smilist at 17 West Merrick Road in Valley Stream) accepted the UHC plan that I was signing up for.

If UHC will not pay 100% so that I can continue seeing Henner - who is the best dentist I could go to in terms of location, does the gas, and how well they perform the services - then UHC needs to find me a dentist that checks off all of the boxes: is in walking distance, does the gas, and UHC will pay for 100%.

Although I don't care much for The Smilist - they gave me all sorts of hassles at the front desk throughout 2023 and didn't perform two procedures with the gas properly - if UHC would pay them 100%, and tell the front desk receptionists that they accept the insurance, that would be great. I didn't get past the front desk when I went in with my UHC card a few weeks ago. That's when the front desk receptionist took one look at my card and told me that they don't accept UHC Community plans.

I cannot continue being without a dentist. Had I known that UHC was lying and deceiving me when I signed up in December 2024, I would not have signed up with UHC.

[UPDATE - 4/3/2025]
Today, I received another physical document in the mail from UHC. Dated March 28, 2025, it seems to be an acknowledgment letter from Kevin C., the Senior Appeals Representative.


I'll give Tischa and UHC a few more days to make some progress on the matter. I'll give her a call early next week if I don't hear from her sooner.

[UPDATE - 4/11/2025]
It's been a week since I've given all of you an update on this matter. Sadly, there isn't much to report. On April 4th and 11th I received the same e-mail from Tischa (copied below). The first gave a date of April 11th, and then on that date, it was updated to April 18th. I'm sure in a week, when that date comes around, it will be changed to April 25th.

Dear Paul,

I am writing to follow up on your complaint. The case is still in progress. I will update you by April 18, 2025, or sooner if a resolution is reached before then.

Thank you for your patience.

Best regards,
Tischa
Executive Consultant, Consumer Affairs

Meanwhile, no one at UHC has found me a dentist that they'd be willing to pay for 100% who is easy for me to get to and who provides gas, so I am without a dentist. Henner checks off those last two boxes, but UHC needs to be willing to pay him 100% of his billed amount, not just for the cleaning done on March 17th, but all future work. Otherwise, they need to URGENTLY find me someone who checks off the boxes and not continue to make me wait while my teeth go unchecked.

[UPDATE - 4/17/2025]
Having grown tired of the non-updates I have been getting since I first heard from Tischa on March 25 - over three weeks ago - I sent several e-mails to her asking for actual details on what's going on and to find out what, if anything, she has personally done to help. Today, I received a secure e-mail reply via ProofPoint that really didn't provide any details at all.

Your Complaint with UHC
From: UHG Consumer Affairs
To: Paul
Sent: 4/17/2025 1:58:02 PM

Dear Paul,

I am writing to follow up on your complaint. I received your email and attempted to call you today, April 17, 2025, at 12:02 PM CST, leaving a message. I apologize for not having more detailed information regarding your complaint at this time. I am collaborating with our internal business partners in dental, appeals, and grievances, who are still researching the issues and will provide resolutions once available.

In the meantime, you may contact Member Services at 1-800-514-4912 for assistance in locating a dentist, as requested in your email. You may also use the chat option in your member portal. Additionally, I have attached a list of in-network dentists in your area. The choice of provider is yours. Please note that this site is for informational purposes only and is not a substitute for medical, behavioral health, dental, or healthcare advice. This directory does not recommend any particular provider or type of care. If you believe you are experiencing a medical emergency, please call 911. Before scheduling an appointment or receiving services, please check with your provider to confirm available services and participation. The directory is updated weekly. If you think any information in the directory is inaccurate, let us know by clicking on 'Report Incorrect Information' on the provider's page or by calling the number on your health plan member ID card.

Your costs may vary due to changes in the provider's contract or status, additional services during treatment, service coverage, or other reasons. Please check with your provider and health plan details to confirm that the service is covered and the costs you may be charged. You are responsible for costs not covered and for obtaining any pre-authorizations or referrals required by your health plan. Regarding your claim with Dr. Henner on March 17, 2025, it was processed and paid, and you have a responsibility of $123.00. This matter is being researched with our internal business partners to determine if an appeal will be made and what the next steps are.

Thank you for your patience.

Best regards,
Tischa
Executive Consultant, Consumer Affairs

Attachments: Dentists.pdf [Ed. Note: This was a zero-byte file]

I'm not even sure why the message was sent securely as there was no personal information in it. Based upon what she wrote, it seems to me that UHC is trying to ignore the fact that UHC reps (and a UHC website) have lied to/deceived me - THREE TIMES! - which has put me in the situation that I am in. Furthermore, it seems to me that UHC does not want to take responsibility for putting me in this situation by not doing anything to get me out of it.

When I was an Aetna member, my high-level contact was Marilyn Gaughan from the Medicare Executive Response team. In early 2023, after having trouble on my own to find a local dentist that did Nitrous Oxide gas who Aetna would *completely* pay for, within a few days, she was able to find me The Smilist in Valley Stream. Although I was never happy with the way I was treated at The Smilist, they checked off all of the boxes, so I continued going there.

When I first received the reply from Tischa on March 25th, I thought that, like Marilyn Gaughan at Aetna, she would take immediate action on the matter and help me to get out of the situation that UHC put me in. Nearly four weeks later, and all I hear from her, in weekly "updates" is that "the case is still in progress".

I just sent Tischa a rather lengthy reply, both securely and through traditional e-mail, which completely re-stated the entire situation and illustrated how THREE TIMES I was lied to/deceived by UHC (the reps and the dental search website).

Why is it taking so long for UHC to do the right thing?