HDHPs charge lower monthly premiums, but they don’t cover the upfront costs of non-preventive medical bills until you’ve met your deductible or spent enough to reach your annual out-of-pocket maximum (OOPM).
Once your spending reaches the plan’s deductible, the insurer begins sharing costs until you hit the OOPM. Beyond the OOPM, the insurer pays 100% of in-network covered services for the rest of the year. This arrangement favors healthy people, who most likely won’t need expensive medical services and can keep enjoying lower premiums.
Cuban, however, wanted to know what would happen if a healthy person does end up needing expensive care — prompting him to ask the question: What happens if you have a million-dollar medical emergency and your insurer refuses to pay? What he discovered led him to a sobering conclusion.
Under the Affordable Care Act, if your insurer denies a large claim, you can request an external appeal from an independent review organization (IRO) and your insurer must follow the IRO’s decision. This setup was created to protect consumers.
The U.S. Department of Labor requires external reviewers to avoid financial entanglements that could create bias toward the patient or the health plan provider, but Cuban doesn’t think it works in practice.
Why Cuban thinks IROs don’t work
Cuban’s social media post, which has generated thousands of reactions and several comments on both platforms, noted that he believes the IROs hired as neutral third parties to evaluate health insurance claim denials are compromised.
He believes IROs make most of their money from the insurer, not the insured, and when there’s a disagreement between a patient and provider, the IRO will most likely side with the insurer. Citing medical review firm ExamWorks as an example, Cuban said he once saw the company issue what he described as a “ridiculous denial” for a patient he was trying to help.
According to Cuban, “the biggest customers of the companies that are the final decision makers for insurance carrier denials, are the biggest insurance companies.” Cuban also noted that the situation “is beyond f—ed up. It’s the definition of conflict of interest.”
Many voices in the health policy community agreed and amplified the post, including executives like Labinot Avdiu, CEO of Medication Management Partners, who called it an opportunity to push for “constructive change and reform.”
Patient advocates have raised similar concerns for years. A KFF analysis of CMS claims data found that around 19% of in-network claims were denied by HealthCare.gov insurers in 2024, and fewer than 1% of those denials were appealed, meaning most policyholders never reached external review.
