Mark Cuban, fresh off a deal with the Trump administration that has already lowered drug costs and expanded patient access, is now asking a question that has frustrated physicians for decades: Why aren't health insurers held accountable for malpractice when their coverage denials cause patient harm?
Dr. Brad Wenstrup, a former congressman and retired Army colonel who practiced podiatric medicine for over 36 years, has been asking the same question for more than 30 years. The answer, he says, remains unchanged: No one is holding them accountable. It is time to change that.
Every physician knows the drill. A doctor examines a patient, reviews history, applies clinical judgment, and agrees on a treatment plan. Then a denial arrives—not from a treating physician or anyone who has seen the patient, but from an administrator following a checklist, with zero accountability for getting it wrong.
Wenstrup recalls his own experience: insurance company physicians who denied care for his patients were often from unrelated specialties and refused his requests to examine the patients themselves. Yet when pressed to accept medical responsibility for their decisions, the denials were frequently reversed. He once told an insurer he hoped the call was being monitored for quality assurance—the next day, the company approved the care plan. Nothing had changed medically, only that someone felt accountable.
The problem is widespread. In the Affordable Care Act marketplace, insurers denied 19 percent of in-network claims in 2024, tying for the highest rate since the exchanges began. In Medicare Advantage, more than four million prior authorization requests were denied in 2024, and over 80 percent of appealed denials were overturned. If those denials were medically justified, why were so many overturned on appeal? The uncomfortable answer: Insurers exploit the fact that most patients will never appeal. Doctors do appeal because they know their patients by name.
The burden on physicians is heavy. A 2024 American Medical Association survey of 1,000 practicing physicians found that doctors and staff spend an average of 13 hours each week on prior authorization paperwork alone. Forty percent of practices now employ staff whose only job is managing that paperwork—time taken directly from patient care. This comes as a recent move by UnitedHealthcare to drop prior authorization for most pediatric care shows that change is possible, but it remains an exception.
The public sees the problem too. Health insurance costs are Americans' top healthcare concern, ahead of drug prices and hospital bills. Ninety-one percent support requiring insurers to pass discounts directly to patients. Eighty-four percent want insurers to disclose how much of their premiums goes toward care versus overhead and profit, and 83 percent want claim denial rates made public. These are not partisan numbers—they hold across Republicans, Democrats, and Independents.
Washington is taking notice. Medicare and Medicaid administrator Mehmet Oz is pushing to streamline prior authorization to accelerate patient care. Congress is also considering policies that would ensure patients can more easily access the care physicians prescribe. As New York explores a Bismarck-inspired path to universal coverage, the need for federal action on insurer accountability grows more urgent.
Every physician who has battled a health insurer knows the system is designed to avoid accountability. Cuban is simply the latest person to say it aloud. Americans are tired of watching insurance companies overrule doctors while patients suffer the consequences. The next step is for Washington to hold insurers accountable with the same urgency it has brought to other healthcare costs. Patients cannot afford to wait.
