And most CEOs are sending the wrong one — without even knowing it.
You can hang your values on the wall. You can run all-hands meetings about culture. You can write a beautiful mission statement and put it on your website.
But nothing — nothing — tells your employees what you actually think of them like your health plan.
Not your perks. Not your ping pong table. Not your remote work policy.
Your health plan.
Because when someone gets sick — when it actually matters — the health plan is the thing standing between your employee and financial ruin. What that plan does in that moment is the truest expression of your company’s values you will ever send.
Most CEOs Have No Idea What Their Plan Actually Does to Their People
I was one of them.
A 78% loss ratio. A 24% renewal increase. And an employee NPS on our health plan of negative 5.
Negative. Five.
I thought we had a good plan. We were paying for it. It had a logo on it. But I had never actually asked my employees what it felt like to use it. When I did, the feedback was brutal — and deserved.
The plan I was running wasn’t a benefit. It was a cost center with a deductible.
Mark Cuban Wrote a Letter Every CEO Needs to Read
Mark Cuban wrote a letter directly to the CEO of Deloitte on behalf of a hospitalized employee who was being denied CAR-T therapy — a treatment called Tecartus — for Acute Lymphoblastic Leukemia. The employee’s doctors had appealed the denial twice. Both appeals failed. Cuban published the letter on LinkedIn.
He wrote: “I’m sure you are not aware of this, but I wanted to bring it to your attention since the future health of one of your employees is in your hands, and your hands alone.”
And further: “Ultimately the decision of whether to override the insurers and pay for the care is yours as the self-funded employer on an ERISA plan. Generally in oncology, every 1 month delay in care results in a 10% survival decrease. In my experience, allowing the denial to stand, will set your employee clearly on the path of palliative care.”
Read that again. Every 1 month delay in care results in a 10% survival decrease.
Cuban wasn’t an outside observer simply writing in outrage. He was writing as a fellow self-funded employer who understood exactly how the leverage worked. On an ERISA self-funded plan, the decision to fight for your employee’s life belongs to you — whether you know it or not.
This is the weight of the job. Most CEOs don’t know they’re carrying it.
The vendor Deloitte chose to administer the plan denied the claim. Twice. And then Mark Cuban had to write to the CEO of a $60 billion professional services firm to explain that the decision was his to make.
The EMPLOYEE PAIN Nobody Talks About
But not every claim is as dramatic as a CAR-T denial. Most aren’t. Most are just Tuesday.
A routine scan. A lab draw. A follow-up imaging order. The drip, drip, drip of ordinary healthcare moments that are quietly burying your employees and their families financially — while you, as the employer, get the added bonus of paying 5x, 10x, or in the case of the comprehensive metabolic panel below, roughly 90x what you should have paid.
Nobody writes a LinkedIn letter about a lab test. But the math is just as broken.
These aren’t hypothetical numbers. These are real procedures from real claims:
| Service | CPT | PPO “Allowed” | Member Paid OOP | Fair / Direct Price | Member Overpaid By |
|---|---|---|---|---|---|
| CT Scan (Abdomen & Pelvis) | 74177 | $3,768 | $574 | $250 | 2.3x the fair price |
| MRI (Brain) | 70551 | $1,956 | $669 | $270 | 2.5x the fair price |
| Comprehensive Metabolic Panel | 80053 | $544 | $390 | $6 | 65x the fair price |
The CT scan of the abdomen and pelvis had a PPO “allowed” amount of $3,768. The fair direct price: $250. The member paid $574 out of pocket — more than twice the cash price, just for their share.
The MRI of the brain: allowed at $1,956, fair price $270, member paid $669.
And then there’s the comprehensive metabolic panel — a routine lab test. PPO allowed amount: $544. Member paid: $390. Fair direct price: $6.
Six dollars.
Your employee paid $390 for a lab test that costs six dollars. Let that sink in. Your employees are paying MORE out of pocket than they would have paid walking in and paying cash. And your plan is paying its share on top of that.
What This Means for Culture
Think about what you’re communicating when your employee:
- Calls the number on the back of their insurance card and gets transferred three times
- Pays $669 out of pocket for a brain MRI that costs $270 at a direct imaging center
- Pays $390 for a lab test that costs $6
- Has no idea what anything costs until a bill arrives 90 days later
You are telling them, in the clearest possible terms: we did not think this through. We bought a product and called it a benefit.
Every CEO gets to decide what their health plan says about them.
The letter Cuban wrote wasn’t a fringe case. Somewhere in America right now, an employee is waiting for their employer to fight for them. Some employers will. Most won’t — not because they’re heartless, but because they never built a system to even know the fight was happening.
Benefits are not a perk. They are not a line item. They are not something you outsource and don’t think about until your renewal.
They are the clearest cultural signal you will ever send to your people.
What is yours saying?
