Customer Story
$35,000 a month was walking out the door. They had no idea.
How a premium pediatric practice in Virginia fixed their dual-coverage billing nightmare and recovered $78,412 in the process.
"We do the hard cases. Sedation, full mouth work on little kids, the stuff other practices send out. Clinically, we're good. But the billing? It was killing us. We'd do $3,000 worth of insurance work and collect maybe $1,800. Took me a while to figure out where the rest was going."
Dr. Priyanka Dutt
Founder, Opulent Pediatric Dentistry
Quick Background
Opulent Pediatric is in Christiansburg, Virginia. Small town, but they pull families from all over because they handle the stuff most pediatric dentists won't touch. Sedation for anxious kids. Special needs patients. Four-year-old who needs full mouth rehabs. Their patients aren't your typical dental practice demographic. These are professional families with corporate jobs and excellent insurance coverage. Many have dual coverage because both parents work for companies with strong benefits packages. Sounds like a dream, right? It's actually a nightmare.
Dr. Priyanka Dutt opened it because she saw a gap. Families were driving 45+ minutes to find a pediatric dentist who could handle complex cases. She wanted to change that.
Most patients carry PPO plans from major carriers like Cigna, Aetna, Delta Dental, and United Healthcare. Premium coverage as per industry standard.
On paper, a healthy practice. But the back office? Total chaos.
Dr. Priyanka Dutt opened it because she saw a gap. Families were driving 45+ minutes to find a pediatric dentist who could handle complex cases. She wanted to change that.
Most patients carry PPO plans from major carriers like Cigna, Aetna, Delta Dental, and United Healthcare. Premium coverage as per industry standard.
On paper, a healthy practice. But the back office? Total chaos.
Annual collections
$5.4mil
Avg treatment plan
$2,400
Patients with two insurances
47%
Here's what was actually happening
Opulent isn't a volume practice. They do big cases, and big cases have more ways to break.
❌ Almost half their patients have two insurances. Which one's primary? Depends on the birthday rule, the plan type, sometimes the custody agreement if parents are divorced. Get it wrong and you're refiling the whole thing 60 days later.
❌ 60% of their cases involve sedation. That means pre-auth requests, medical necessity documentation, and time logs that have to match exactly. Miss any of it and you're denied. And sedation isn't cheap. We're talking $600-900 just for that piece.
❌ Treatment plans run $2,400 on average. These aren't single visits. It's crowns, pulpotomies, sedation, follow-ups. Each one bills separately. Each one can fail separately.
❌ Special needs kids need extra paperwork. If a child has autism or sensory issues and needs sedation, insurers want to know why. "Patient is anxious" doesn't cut it. You need behavioral notes, diagnosis codes, the whole thing.
❌ Almost half their patients have two insurances. Which one's primary? Depends on the birthday rule, the plan type, sometimes the custody agreement if parents are divorced. Get it wrong and you're refiling the whole thing 60 days later.
❌ 60% of their cases involve sedation. That means pre-auth requests, medical necessity documentation, and time logs that have to match exactly. Miss any of it and you're denied. And sedation isn't cheap. We're talking $600-900 just for that piece.
❌ Treatment plans run $2,400 on average. These aren't single visits. It's crowns, pulpotomies, sedation, follow-ups. Each one bills separately. Each one can fail separately.
❌ Special needs kids need extra paperwork. If a child has autism or sensory issues and needs sedation, insurers want to know why. "Patient is anxious" doesn't cut it. You need behavioral notes, diagnosis codes, the whole thing.
My front desk was spending more time on the phone with insurance than talking to parents. We're supposed to be a premium experience. That's the whole brand. But behind the scenes it was chaos.
- Dr. Priyanka Dutt
Founder, Opulent Pediatric Dentistry
After Lavender Dental
Metric
Before
After
Days in A/R
51 days
18 days
Sedation denials
28%
4%
Collection rate
90%
97%
Dr. Dutt's evenings
Aging reports
Her kids
Her team talks to families again. Front desk isn't on hold with Cigna all day. They're actually doing the job they were hired for.
Big cases aren't scary anymore. Before, a $4,000 treatment plan meant $4,000 worth of billing headaches. Now it's just... a case.
She's growing again. Adding another sedation day. Looking at a second location. Stuff she'd put on hold because she couldn't handle more billing chaos.
"$420,000 a year. That's what we were losing. I could've hired two associates with that. Could've opened a second location. Instead it was just sitting in insurance limbo while we argued about birthday rules."
Dr. Priyanka Dutt
Founder, Opulent Pediatric Dentistry
What Lavender actually did
Took over the billing. Rebuilt the whole process around how their cases actually work.
🦷 We sort out the two-insurance thing before they even come in.
Both plans verified, primary vs secondary confirmed, everything documented. By the time the kid’s in the chair, we already know exactly how the claim flows.
⚡ Sedation pre-auths go out 10 days before the appointment.
Every time. No “we’ll figure it out later.” If pre-auth isn’t confirmed, the case doesn’t get scheduled.
🗺️ Big treatment plans get mapped out in advance.
What gets billed when, to which insurance, in what order. No missed charges, no surprises.
🛡️ Anything over $1,500 gets tracked individually.
If it hasn’t paid in 21 days, we’re already calling. No more claims sitting there for months.
📋 Special needs documentation is templated.
Behavioral notes, diagnosis codes, clinical justification. Gets attached automatically so nothing’s missing.
💰 First month, we caught $18,000 in COB errors.
That would’ve become denials. That alone paid for six months of working with us.
🦷 We sort out the two-insurance thing before they even come in.
Both plans verified, primary vs secondary confirmed, everything documented. By the time the kid’s in the chair, we already know exactly how the claim flows.
⚡ Sedation pre-auths go out 10 days before the appointment.
Every time. No “we’ll figure it out later.” If pre-auth isn’t confirmed, the case doesn’t get scheduled.
🗺️ Big treatment plans get mapped out in advance.
What gets billed when, to which insurance, in what order. No missed charges, no surprises.
🛡️ Anything over $1,500 gets tracked individually.
If it hasn’t paid in 21 days, we’re already calling. No more claims sitting there for months.
📋 Special needs documentation is templated.
Behavioral notes, diagnosis codes, clinical justification. Gets attached automatically so nothing’s missing.
💰 First month, we caught $18,000 in COB errors.
That would’ve become denials. That alone paid for six months of working with us.