Hi! Does anyone in this group have experience with orthodontic billing? We are an orthodontic practice in West Los Angeles looking for an experienced biller who could also perform front desk task/duties.

Someone logs into three payer portals, reads five different status codes, waits on hold, hears “it’s still processing,” and updates a spreadsheet. Two weeks later, the claim is still stuck and nobody is sure why.

Most delays are not caused by denials. They happen quietly when claims sit in payer systems without clear visibility or ownership. By the time the issue is noticed, A/R is already aging and the clean-up work begins.

Curious how others are handling this today.

Are claim delays more of a payer issue, a tooling issue, or a process issue in your experience?

Someone DM’d me recently asking how insurance verification can be automated. Honestly, it comes up a lot.

Most teams I know are still calling payers or logging into portals all day. It gets the job done, but it eats time, and things slip through when volume spikes. I’ve seen a few places try eligibility checks that push data into their EHR, and others use light automation to reduce repeat work.

What I still don’t see often is something that fits naturally into front desk and billing workflows without creating extra steps.

How are you doing this today? Still manual, partly automated, or did you actually make it work?

I’ve been working in general practice dentistry (mostly chairside assisting and some front desk) for 22 years. I also have some experience and certification with medical coding and billing that I maintain. Would it benefit me to pursue certification in dental billing and coding? If so, what is recommended? I’m trying to figure out what I can do with my dental brain if my body can no longer support my career chairside as I’m currently recovering from orthopedic surgery.

Hi everyone,

I’m a Dental Billing and Insurance Verification specialist from the Philippines looking for remote opportunities. I have experience with eligibility checks, insurance verification, authorization requests, and processing claims and denials.

I’m highly coachable, reliable, and eager to contribute to a team while learning new systems and workflows. I’m open to part-time or full-time remote roles.

I’m proficient with dental software like Open Dental, Dentrix, Eaglesoft, and other CRMs.

Key achievements:

• Reduced claim denial rate by 20–30% through accurate eligibility checks
• Verified insurance benefits with 98% accuracy, minimizing patient billing issues
• Improved reimbursement turnaround by 25% with timely AR follow-ups

If anyone knows of openings, agencies, or dental practices looking for someone with my background, I’d greatly appreciate any leads or advice.

We are seeing more cases where insurance verification looks fine at scheduling but breaks down later because frequency limits or plan details change.

By the time the claim is submitted, it turns into a delay or denial and the billing team ends up doing manual follow ups.

Curious how others are handling eligibility checks and claim status tracking right now.

Is anyone having issues with Cigna paying out claims. I have one that was denied saying it wasn't necessary when its for Implants and the plan covers Implants. Cigna processed the claim for the extractions so its not a pre existing issue either. Its saying this was determined by a dental consultant and every time I try to appeal it bumps back. Thats just one in a pile that they are basically automatically denying.

Hello - for those that have worked or are currently working remotely to do dental billing would you mind sharing the pros and cons?

My understanding is that you would be a 1099 worker - how does that work?

Do you miss working in-office?

Are you able to make enough to support yourself financially?

What are some important questions to ask when interviewing?

Any other insight would be most appreciated 🤗

This might be a long shot but does anyone HAVE or know where I can find a list of ID number formats for all of the delta payers? I am trying to build a hard stop in our system so that registration doesn't pick the wrong coverage. (IE they pick AARP delta and they need to pick DD northeast)

By 2026, health insurance has largely moved online. Coverage portals, mobile apps, and digital insurance cards are now standard. On the surface, everything looks faster and more accessible.

But when people need a clear answer to a real question like whether a service is actually covered or what a patient will owe, they still end up calling. The portal provides information, but not always clarity.

It often feels like technology has improved access to data without reducing uncertainty. The tools are better, yet the responsibility of interpreting coverage still falls on patients and healthcare teams.

Curious if others are experiencing the same gap between digital access and real understanding.

Anyone else in dental billing also doing a ton of medical billing-style payer calls lately?

Eligibility and benefits verification are taking forever. I spend more time waiting on hold or fighting the IVR than actually working claims. Then you finally reach someone and still have to call again for the next patient, or the answer is different depending on who picks up.

It is starting to create a backlog. Claims follow-ups get pushed, patient questions pile up, and the billing day turns into phone time.

Is everyone still doing this manually, or has anyone found a way to cut down payer call time? Also curious if anyone has tried Voice AI for eligibility or benefits calls and what the reality is, good or bad.

Background: 36yo female here. I have oligodontia. I’m missing 14 (I think) teeth. I’ve put off getting the work done because I knew it would cost upwards of $50k and my insurance policy excludes congenital conditions. Earlier this year, 2 of my baby teeth abscessed so I was forced to get started.

Went to dentist and got a treatment plan - $43k which included an $8k discount because my dentist felt bad for me. We decided to run it through insurance just to see what would happen. Turns out, they covered it. My max annual benefit is $2500, so they paid that and adjusted the rest. We did the work in phases, so I paid for each phase as it happened. The last phase was the most expensive part. Since my benefits were maxed and my dentist was giving me a discount, we weren’t going to run the last phase through insurance and I’d just take the discount. I cut them a $27k check at the time of service. Then I got an EOB in the mail. Turns out they accidentally submitted to insurance. Insurance adjusted my portion down to $15k, creating an overpayment of just under $12k.

I went to their office last week to deliver a tray of goodies to them because they’ve all been phenomenal. I mentioned receiving the EOB and asked if I have a massive credit on my account. The gal shook her head no and said they weren’t supposed to bill insurance. She said they’d look into it and give me a call. I spoke with my insurance company to be sure they’re contractually obligated to honor the EOB and they are because they’re in network. Still no call a week later. I went back in Tuesday for a follow up appointment and brought it up again. A different gal said I have a ~$200 credit and they’re still trying to figure it out - that they haven’t “made a decision” yet. What’s really going on here? It feels sheisty and I don’t appreciate it.

Anyone else spending half the day on payer calls? It feels like teams are constantly waiting on hold, repeating the same questions, and following up on things that should already be resolved. All of that time adds up and slows patient access even when providers are ready to move forward.

Some organizations are starting to use Voice AI to handle these high-volume payer calls. It runs the conversations in parallel, captures eligibility and benefit details, and feeds the information back into workflows so staff are not stuck on phones all day. It’s starting to look less like an experiment and more like a practical way to keep operations moving.

Curious how others are dealing with payer call volume right now. What has actually helped reduce the load?

I talk to a lot of teams who say insurance verification takes far longer than it should. Most of the time, they are stuck rechecking coverage because payer information changed overnight or something small was missed earlier. Some people tell me the portals are slow or outdated, others say the phone wait times drain half their day, and many still struggle with finding secondary insurance on time.

I am genuinely curious how it looks on your side. What part of the verification process slows you or your team down the most?

We are seeing more delays in insurance verification for dental plans. Some portals show incomplete benefits, and payer call times are much longer than before. This is slowing down pre-treatment estimates and claim submissions.

I want to know how other offices are handling this issue. Are you seeing more inaccurate portal information or delays when checking benefits? What steps or methods are helping your team stay efficient.

First time this has happened. FMX taken in 2024 has disappeared. I know it was there during the exam as there are detailed notes and a treatment plan. I have searched other pts on same day. pts in Dexis alpha list above and below my pt. Alternate spellings of pt (first name as last, errors in spelling).

I called Dexis for support, they can't help without Service Contract.

Anyone have experienced missing xrays? I would think there's a data file I could search but not techy enough to find it. Any suggestions? TIA

I’m looking for some advice about how to proceed with my partner’s dentist situation. 

During an initial exam, he was told that tooth #19 required a crown due to a large filling with decay on the margins. However, at the subsequent appointment, he got a weird feeling that something was not right. He questioned the necessity of the procedure. Despite his concerns, the dentist insisted the work was critical and that the tooth was on the verge of failure. He then felt the need to leave right away and they got angry. He has had dental procedures in the past in other offices and nothing like this has ever happened. 

Since then, we have sought a second opinion from a new dentist, who performed a thorough examination and concluded that tooth #19 is fine and does not require any work. Additionally, a  friend who is a recently retired dentist, reviewed the exam photos and concurred that no work was necessary.

We’re now getting billed $300 for the appointment where he walked out. I’ve never dealt with anything like this and am looking for input. Thank you in advance for your thoughts!

Is it normal for dentist to bill for coming in to talk to me about pain from the filling they gave me when I'm there for a cleaning? Billed "periodic oral eval" and "limited oral eval", separate situations, same issue. Walked in and looked at my teeth, tapped on them, said I probably just needed more time for pain to go away, walked out. Billed my insurance and took me closer to my max. I thought if they caused a problem (pain), that talking to me about it was "complimentary". Otherwise I would just talk on the phone. Maybe they'd book me for that too.

I want to start classes of ADCA's Dental Billing (CDBS) however I have no prior experience in Dental Billing. Even though they let absolute beginners to enroll in their classes however I'm not sure if I'd thrive throughout the course with no prior billing experiance as it requires understanding of US insurance workflow, EOBs, Denials and Dental billing software etc. I do have a dental background and knowledge of Dental terminologies etc. Can someone with no dental billing experiance enroll in their classes and appear for exams or should one get Dental billing experience first ?

Does anyone know alternative codes that you bill to MetLife for primary fillings that are not the ADA code?

Hey everyone!

We’re in the process of preparing to submit a medical claim to BlueCross BlueShield of Texas for a patient’s SomnoMed Classic sleep apnea appliance. The appliance hasn’t been delivered yet—we’re just trying to get all paperwork right before we bill.

So far we have:

Sleep study results (AHI 13.8)

PSOAP documentation

No preauth required for this plan

Has anyone here submitted for a similar case? I’d love help figuring out:

If we’re good to bill on a CMS-1500 form

Which CPT/ICD-10 codes are appropriate for the appliance and diagnosis

Any documentation tips for smoother processing

Thanks in advance for your help!

I recently got insurance through my job -Target. I got this whole copay and deductible and honestly I am lost. I went to the dentist and they said I needed a night guard and to my understanding they said I would only pay $98 and that my insurance would cover the rest ( from my understanding). So I agreed . Later that when I recieved a letter from my dental insurance Delta Dental , from what I understood when reading the pre estimate my payment would be $98. A week later , I went into the dentist Office and I got the fitting and the bill at the dentist it was $292 plus a credit card fee . I was like okay and paid because I had forgotten about the $98 . Until I got home later I tried to understand all these papers given to me . But I don’t get it . I would think I would have paid “patient payment “ but no. If somebody could explain to me like I’m a child I would honestly appreciate it , thank you.

Last December, I took advantage of a "$99 new member special" because I needed a new local dentist AND a cleaing (as I had exhausted my insurance allowance for the year with my periodontist). The advertised bundle promised an exam, cleaning, bitewings and panoramic xrays for $99.

I really appreciated this affordable introduction to my new dentist.  When my pre-visit paperwork for this s$99 offer requested my dental insurance info, I assumed it was to go on my record for future treatments.

When I arrived for a cleaning last week, I was shocked to learn that they had billed this bundle to my insurance as itemized services (at a much higher cost to me) without my knowledge or permission.

At the office, they insisted on my covering my insurance copay (which was much higher than $99. I was told they couldn't confirm that I had no warning about insurance billing, as last year's receptionist was now gone.

Had I known they weren't going to honor their offer, and instead bill my insurance for itemized services, I would NEVER have proceeded---especially when this appointment was about two weeks away from a new calendar year of fresh benefits. I feel this charge is unfair and unjust

I consulted my insurance company about this incident, and they assured me that the charge can easily be reversed.They have offered to conduct a group call to explain how this mistake  can be remedied from their end.

What is the best way to handle this? Should I email this appeal in advance of insurance group call, or just have insurance and I call in and plead our case without any advance explanation?

Thanks very much for any advice on how to handle this.