As the Administrative Assistant, Insurance Department Head, Financial Counselor, and Accounts Receivable person in a small dental office, I have learned much more about Medicaid than I really care to know. From my standpoint, it is more of a headache than it is worth. I am well aware of the reasons many dentists are reluctant to accept Medicaid patients, however, because I am also aware of the needs of many of my neighbors in this small community, I view Medicaid as something we have to deal with in our office.
In most cases, Medicare pays less than half of our charges for treatment. Because dentists are an ethical bunch, my doctors give their Medicare patients the very same quality of care they give to all their patients, and spend the same amount of time with them, but are paid for only a fraction of the value of these services.
Medicare in our state is understaffed and overloaded, which results in a lot of mistakes on their end. Many claims are returned to our office partially paid, paid to the parent instead of the child, with covered, preauthorized services denied, or for fictitious reasons, one of the most recent being that “The patient’s name does not appear in Box 20”. Per a phone call to Medicaid I was told there is no reason for that claim to be denied and I should resubmit it (and wait four more weeks for payment!).
Mistakes-theirs or ours-can take months to correct, and all are our responsibility to fix. A mistake on a partially paid claim must be corrected by filling our a computer generated form, mailing this form and waiting. And waiting. And waiting some more. In our office we keep copies of everything we send and write notes on the copies for verification of what has happened and the name of the MA person we spoke to. And still it is very confusing, especially when there is such a long period of time before a response is received.
There are multiple reasons why dentists do not accept Medicaid; delays in payment and inadequate payments are only part of the problem. Many of our Medicaid patients are faithful about keeping up with routine visits, and take care of their oral health. But there are just as many who don’t, and who have complete disregard for our schedule and our time, as well as disregard for their own health. It is frustrating for our doctors, assistants and hygienists to try to help people with this attitude.
Personally, it is frustrating, but I have learned to deal with the missed and cancelled appointments. My biggest problem with Medicaid patients is the fact that most of them have no understanding of how the program works, of the generosity of the few dentists who agree to see them. While we treat many Medicaid patients who have been with us for years, we do not accept new Medicaid patients. Often, callers are very indignant, as if we are obligated in some way to accept them as new patients. I hear “Well, you’re guaranteed payment” (yes, 50% if we’re lucky) or “Well, this will be paid 100%” (for them, not us).
I wonder what Medicaid recipients are going to do, as there are fewer and fewer dentists, farther and farther apart, who will accept them as patients. Dental offices cannot operate on the percentage of payment offered by MA and cannot cope with the aggravation of dealing with a multitude of denied and mishandled claims if the office is overscheduled with Medicaid patients.
Please understand-I realize there are many who need help to maintain their health, dental or otherwise. I would appreciate some help myself, however I’m one of the lucky ones who pays $500/month out-of-pocket for the privilege of sharing a BCBS family plan with my husband. I do not qualify for help of any kind, and am not even given the choice to purchase a cheaper, individual policy of my own within this company.
Medicaid is not the only insurer causing problems for patients and providers.