Periodontists - Madison, MS

"I was scheduled for wedge and osseous surgery with IV sedation in April 2018. The treatment plan provided by the doctor had the wrong Aetna (my insurance provider) member rate values and an overestimate of what my obligation would be. It’s unclear how the values were obtained. Aetna stated to me that the Plan might be revised prior to surgery; it was not. Aetna stated that member rates would be used regardless and I should expect a bill of around $700. The day of surgery I was charged over $1700. I should have walked but I paid the amount. I later found out the doctor has issues with some insurance providers and prefers to overcharge her patients and then refund any excess. (That is, if the patient doesn’t walk at the presentation of an outrageous bill, which may be the real intent.) Regarding the sedation, I believe I was awake during the surgery; the doctor believed I just imagined everything. Unfortunately, it was very real to me and I viewed her response as flippant. The surgery was good – little pain, swelling or bleeding. I did not need the prescribed pain medications. This aspect exceeded my expectations. The doctor is skilled in this respect. The sedation aftereffects were terrible, essentially wiping out the remainder of the day of the surgery and part of the next day. I was a nauseous zombie. The procedure lasted almost an hour and the doctor stated that the surgery duration required multiple doses of the sedation drugs. This was not consistent with my previous (non-dental) sedations. The follow-up visit was brief; some of my questions were answered. My questions on how successful the surgery was and what the ultimate results would be were not clearly answered and almost evasive. The doctor seemed surprised, then irritated, that I had questions on sedation drugs and the aftereffects; apparently, I was wasting her time. I called back to get additional information and was provided a surgery record which met my needs. As noted, I was required to pay a very large upfront fee. In May 2018, I was refunded about 75% of the overpayment with a note saying insurance reimbursements were the reason for the initial overcharge/refund. That was clearly not the case. I provided a letter requesting the remainder and another 5% was refunded in June. My letter was not directly responded to. The doctor’s staff stated in a telephone conversation that because I was past my maximum insurance benefit, state law allows the doctor to charge what she wants at that point, and she did, essentially keeping the remaining 20%. Her contract with Aetna is moot at that point. For a self-insured insurance plan, state law is not applicable, which I believed to be my case. I should have stated that but the snarky staff response to me precluded that. I should have written a second letter but did not. I corresponded via email and telephone with Aetna seeking clarification on covered expenses and was essentially told the doctor was obligated to refund the remainder of the overcharge. I requested an appeal to Aetna to confirm the email correspondence, to essentially tell me in writing who is lying to me – Aetna or the doctor. Aetna responded in July in a letter noting the disputed amount should be refunded to me in 4-6 weeks and that they (Aetna) had communicated that to the doctor. Aetna considered the matter closed. In August, with no additional money refunded, I requested clarification from Aetna again and Aetna initiated another appeal. The doctor requested and received (quid pro quo?) an opinion from the State of Mississippi’s Insurance Commission that she was in the right. FOIA showed that the Commission advised her that self-insured plans would not be covered, which I verified with the Commission. The doctor’s correspondence to the Commission referred to me and other patients as “angry” and our insurance agents as “aggressive” and that we were somehow besmirching her good name by calling her “greedy.” I have not publicly referred to the doctor in a negative manner other than here and in private conversations with Aetna and my former employer (I am retired) who provides the insurance that Aetna administers. Aetna has behaved appropriately towards her per my conversations with them. My employer has not dealt with the doctor and most likely will not. It’s now December and I still have no resolution. The doctor has a liability if she acknowledges her error and I understand her reluctance to not acknowledge this. Aetna wants everyone to play nice so they don’t have to do anything; it’s like herding cats dealing with them and getting them to be somewhat accountable. Going forward, I believe that Aetna is the real culprit here – it is Aetna that essentially allowed the doctor to run wild. I have received emails, letters and verbal correspondence from Aetna justifying my position or the doctor’s. In the end, I believe Aetna manages my plan as a fully insured one versus a self-insured one, with the implied consent of my employer. Aetna does not want to have to deal with various types of plans or to impose that upon their doctors. This is the first doctor that I have had that refused to accept member rates. I do not know if the doctor is greedy or lacks a moral compass. I cannot really comment on her apparent arrogance. But I am tired of dealing with this nonsense. I naively thought the right thing would be done since it was so obvious, at least to me. I was wrong in many respects. Has it been worth it? No. Would I do it again? No. Do I recommend this doctor? No. I have written the doctor, apologizing for some of my actions, since those actions caused this sorry ordeal to drag out for so long. I was not allowed to post a review on her site. "