I have always gotten the right answer eventually from every health insurance company on every health claim I have dealt with. Each and every insurance company honored their insurance policy and correctly paid what was due (or had a valid reason to decline a claim). Most claims were handled correctly and timely without any intervention.
This included the Kansas Health Insurance Association (the Kansas health insurance risk pool) which paid over $500,000 for my brother’s lymphoma treatments over his two year illness. It gave him access to any treatments that were appropriate. The final cost to him, in addition to his monthly premium, was his deductible and cost sharing of $3000 for each of the two years ($6000 total).
The core value of any health insurance plan is offsetting the huge