(A News and Sentinel Op-Ed - Photo Illustration - MetroCreativeConnection)

I have practiced orthodontics in Wheeling for 45 years. I have sat across from parents who budget carefully for braces, cleanings, and routine dental care. I have watched families try to stretch insurance benefits that look much the same as they did nearly half a century ago.

Now, we have numbers that confirm what many of us have seen firsthand. The West Virginia Office of the Insurance Commissioner recently released updated dental loss ratio data. On average, only 43 cents of every premium dollar in our state goes toward patient care.

Think about that for a moment. Families and employers pay premiums expecting coverage for dental services. Yet more than half of those dollars never reach the patient.

A dental loss ratio measures how much of premium revenue is actually paid out in claims for patient care. When that percentage is low, it means more of the money is going to insurers’ administrative costs and overhead, instead of treatment.

For patients, this shows up when needed care is delayed by insurance companies. It shows up when treatment has to be spread over multiple years because benefits run out. It shows up when families discover their annual maximum has already been reached.

This is where the numbers become personal. Most dental plans cap annual benefits between $1,000 and $1,500. Those caps have barely changed since the 1970s, even as the cost of care has risen. Many West Virginians are underinsured.

Transparency is an important first step. We commend the Insurance Commissioner for releasing this information. The public deserves to see how premium dollars are being used.

But transparency alone is not enough. That is why the West Virginia Dental Association is spearheading Senate Bill 548. The bill would establish a clear standard: at least 85% of premium dollars should be spent on patient care. If insurers fall short, the difference would be returned directly to policyholders.

That is accountability. If families are paying premiums for care, most of that money should go toward care. It is a simple principle.

This legislative session gives lawmakers an opportunity to respond to facts with action. The data is now public. We know where we stand. We know how West Virginia compares nationally. And we know that 43 cents on the dollar is not good enough.

I encourage residents to contact their legislators and ask them to support Senate Bill 548. An 85% patient care standard will help ensure that premium dollars are used primarily for their intended purpose: patient care.

Now that we have clarity, it is time for accountability.