When it comes to health care, the older we get and the more we have to see doctors, the more people find themselves facing upsetting situations.
People often fight to have certain medications covered by their insurance providers, which can cause immense stress if a person relies on them.
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There’s also a newer problem around reconstruction surgery for patients who’ve had both breasts removed.
Doctors are coming forward on social media to reveal that patients seeking diep flap surgery — a reconstruction process that uses the patient’s own tissue to reconstruct the breast — have been turned away by surgeons because “Medicare won’t pay enough” for them to do the procedure.
Situations like these can leave patients in need of care feeling hopeless and unheard, not to mention mistrustful of the health care industry.Â
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Now Cost Plus Drugs founder Mark Cuban is sounding the alarm on a new health insurance problem, and it’s one that people should be aware of.
Mark Cuban wants people to know about an emerging health care challenge.
Image source: Beverly/WireImage
This health care problem could destroy small businesses
On June 16, Cuban reshared a tweet from the X account WallStreetApes that featured a video of a female doctor explaining a worrisome new issue concerning surgeries.
Doctor Ritha Belizeaire is a general and colorectal surgeon who works for Houston Community Surgical.
In the post, Belizeaire explains a new issue she’s seeing pop up in the U.S. health care system.
“If you’ve ever wondered why doctors are going out of network with insurance — meaning they’re not taking insurance anymore — I’m gonna give you just one piece of information as to why that’s happening,” she said.
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Belizeaire goes on to tell the story of a woman she operated on in February. After the operation, she billed the insurance and was paid about a third of the cost. But four months later, the insurance company reached out by mail to inform her they had overpaid and wanted to be reimbursed, a process that she explains is called a “clawback.”
Belizeaire goes on to say that the insurance company threatened to withhold future claim payments if she did not pay the amount they asked for, and shows documentation proving her story.
“These are the games that insurance plays,” she finishes. “As someone who is a small business owner and a physician who wants to provide great care for their patients, this just causes undue stress and makes owning a small practice unsustainable.”
Cuban commented on the reshared post, saying, “This is one more reason why companies should direct contract with providers. Insurance companies underpay providers all the time.”
Mark Cuban vs. Big Pharma
Cuban has been on a mission to do something about this problem, as well as many of the other customer complaints about the health care system, with the founding of Cost Plus Drugs, which he started in 2022 as a way to eliminate the middleman around drug pricing.
Cost Plus now carries hundreds of medications people badly need at affordable prices in an effort to disrupt the drug industry, and it’s transformed Cuban into an important figure in the health care space.
While he’s done a lot already, the billionaire has made it clear there’s a lot more change he’d like to make happen.
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When asked by a commenter in the thread what the first two things he would change would be if he was in charge of the U.S. health care system, Cuban had an answer at the ready.
“Still have work to do on the numbers, and this is off the top of my head,” Cuban started. “But I would allow patients to pick whatever cash pay provider that honors their published price. Have the patient commit to what they can afford to pay (with documentation) and have taxpayers finance what they can’t.”
“With repayment being deducted from their paychecks, but limited to no more than 10% of their check and all unpaid debt written off without penalty after 15 years,” he continued.Â
“There would be zero premiums to insurance companies. But you would pay $400 to $500 per month, for your family, for re-insurance, capped at $50k. So you never incur more than that in annual medical expenses.”
Cuban’s vision goes even further, cutting many of the systems Americans rely on.
“No PBMs. No health care from employers. You could buy private insurance if you wanted to,” he said. “Medicare and Medicaid would go net pricing on meds. And fee for service for needed services like claims processing and other required services. Again, off the top of my head. Numbers are guesses based on my companies.”
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