By Nika Hettlinger, DDS
President, West Virginia Dental Association
People who pay for dental coverage expect it to work. Too often in West Virginia, it does not.
I have been a dentist in Cabell County for nearly 20 years, and I see this every day.
Most of my patients are working people. They do what they are supposed to do. They work hard, take care of their families, and pay for dental coverage every month. More and more often, they sit in my chair asking the same question: Why can’t I get the care my coverage is meant to provide?
Across our region and throughout West Virginia, patients with dental benefits are running into delays, denials, and confusing limits that block access to care. Treatments that should be handled quickly get stuck waiting for approvals. Sometimes they are denied outright.
When care is put off, small problems become big ones. A tooth that could have been treated early turns into pain, infection, or tooth loss. Patients end up paying more out of pocket or skipping care entirely, even though they have coverage.
Many people assume dental coverage works like medical coverage. They expect that if their dentist recommends care, their plan will help pay for it. When that does not happen, frustration builds. Patients feel caught between what their dentist knows is right and what their coverage will allow.
As dentists, our responsibility is always to our patients. We recommend care based on training, experience, and what will keep people healthy. Too often, dental benefit managers override those recommendations. Patients are left wondering why someone who has never examined them gets the final say on their care.
That raises an important question: Where is all that premium money going? In West Virginia, dental benefit managers are not required to spend most premium dollars on patient care. As much as 40 percent can go to overhead, profits, and executive bonuses instead of cleanings, fillings, and preventive treatment. Families pay every month, but there is no basic rule ensuring their money is used for care.
That is why the Dental Loss Ratio matters. It is a simple accountability and transparency standard that would require dental benefit managers to spend at least 85 percent of premium dollars on patient care. If they fall short, the difference would be refunded to patients. It is a practical fix that can help reduce denials and delays.
The Dental Loss Ratio is a practical step toward accountability and transparency. It helps ensure that more of the dollars families pay each month are used for patient care.
The West Virginia Dental Association is supporting this legislation during the current legislative session to help reduce delays, improve access, and strengthen dental benefits across the state.
West Virginians who want dental coverage that works should contact their lawmakers in support of this legislation and learn more at MoreForYourSmileWV.com.
