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Opinion: Dental insurance in West Virginia is at a crossroads

WV Dental Association supports HB 2604 and SB 290

From the West Virginia Dental Association

It doesn’t take much to see how poorly dental insurers are serving people under the current system. More than half of Americans delay getting medical care — or avoid it altogether — because of burdensome costs, and the most frequently skipped form of care is dental work.

Compounding that problem in West Virginia, many dentally-insured patients are losing access to their dentist of choice.

  • Many dentists are refusing the excessive demands insurance companies place on their dental care delivery.
  • Dental insurance patients are shocked to learn their private insurance reimburses less than Medicaid for many procedures. The most well-known dental insurance company reimburses 16% less than Medicaid for a root canal and 32% less than Medicaid for an adult cleaning in West Virginia!
  • The decades-old $1000 limit on coverage buys much less today – especially with recent inflationary pressures.
  • Up to 40% of dental insurance premium dollars are kept by insurance companies to cover administrative costs rather than the actual cost of care.

That is why the WV Dental Association is supporting the Dental Insurance Transparency Act, which would require more transparency from dental insurers about how they spend their money. Your State Legislature will have an opportunity to help fix this problem by passing House Bill 2604 or Senate Bill 290.

How? Dental insurers, who are exempt from certain federal regulations, ought to be held to higher standards. The proposed legislation will:

Require Transparency: Patients deserve visibility into how much of their dental insurance premiums are paying for their oral healthcare – as opposed to dental insurer administrative, marketing, and operations costs.

Increase Accountability: Available data indicates that up to 40% of dental premium dollars are used by insurance companies to cover administrative costs, profits and executive compensation, instead of being directed toward patient care. Reporting requirements can restore employers’ confidence in their choice of plans when providing a dental insurance benefit to their employees.

Enhance Consumer Protection: The lack of adequate consumer protections for dental patients has allowed dental insurers to put their own profits ahead of serving consumers and supporting the oral health of patients. By requiring that a minimum share of premium dollars be spent on patient care, dental insurers would be given a meaningful incentive to expand the number of procedures they cover or reduce out-of-pocket expenses if their medical loss ratio is below that threshold. Otherwise, insurers would have to reimburse their clients.

Ensure Parity: Dental insurance plans have not been subjected to the Affordable Care Act’s 80% MLR mandated standard for health plans. Addressing this disparity in West Virginia through a dental loss ratio reporting requirement would hold dental plans accountable for prioritizing patient costs over profit.

Given how much more coverage people get from their medical insurance than they do from dental insurance, it’s clear that setting some baseline for how premium dollars are spent ultimately benefits consumers.

West Virginia dentists care about their patients, and it is unfair that patients’ money is being spent on administrative costs rather than paying for actual patient care. Overhead costs, profits, and executive compensation should not outweigh the priority of providing residents of our State with accessible, affordable dental health care.

As the mouth-body connection between dental health and overall physical health is better understood, it is clear that healthy mouths are essential to healthy bodies! Please encourage your state legislator to support the Dental Insurance Transparency Act today.

Travis Wills, DDS
Shady Spring, WV
2023 President, West Virginia Dental Association [email protected]

Dan Carrier, DDS
Morgantown, WV
2022 President, West Virginia Dental Association [email protected]