Medicaid and Orthodontic Case Acceptance
In the United States, Medicaid is a benefit that is generally provided to families of limited financial means to obtain health care services that they might not be otherwise able to afford. (For those of you in other countries where we work, you have similar programs).
Some of you accept Medicaid from patients as a way to finance treatment, and for those of you who choose to do so, accepting Medicaid patients is a commendable practice policy that provides the opportunity for treatment to those who would otherwise not be able to attain it.
For practices who do not accept Medicaid, the success rate in starting such cases has been, in my observation, close to zero, which is what one would expect. This makes scheduling and conducting such consultations an unproductive (and expensive) hour of your and your staff’s time, and also serves no purpose for your visitor other than the benefit of providing an education.
Since the educational benefit can, and should, be provided by a Medicaid-accepting practice that can also address the patient’s financial needs, the issue becomes one of how to best direct the Medicaid patient to the appropriate resource. This is, of course, the domain of your front desk staff, and it is yet another reason for you to ensure that your personnel on your phones are properly trained.
The correct way to professionally handle Medicaid inquiries is to use a business skill known as ‘qualifying’, and this is how we teach your staff to do it.
One question that you may already be asking is if the caller will be using Medicaid to pay for treatment. If the answer is yes, most of your staff currently make a note of this, and then go ahead and schedule the appointment.
That is where the mistake is made.
Instead, the staff person should respond to a “yes” by politely explaining that the office does not accept Medicaid, and that there will be an out-of-pocket down payment as well as monthly payments. Caveat: I recommend that estimated numbers are provided here – a good ballpark of your minimum accepted down payment and the monthly obligation is appropriate – and I will explain why in a moment.
The staff person then asks the caller if these numbers are within their budget: “is that going to be workable for you?”
If the answer is “yes” – and this does happen on occasion – the appointment should be set.
If the answer is “no” – and it usually is – the front desk should, from a list kept on hand for this specific purpose, refer the caller to a practice that accepts Medicaid and can therefore help them.
This process serves everyone concerned: the patient gets the help that they need without having their time wasted, and that same benefit is extended to the doctor and staff.
If done properly, this should virtually eliminate the time management problem involved here.
Lastly, I realize that most of you do not like to quote fees over the phone. I recognize that you normally do not do so without an exam, and for qualified buyers, that is the correct policy.
However, this is a situation where the objective is the opposite of the normal goal of scheduling an appointment. If fact, for all parties concerned, here we are actually trying to avoid one.
