There should be no such thing as a "coverage decision", outside of you and your doctors deciding on a course of treatment. The fundamental source of the rot in

There should be no such thing as a "coverage decision", outside of you and your doctors deciding on a course of treatment. The fundamental source of the rot in the healthcare system is that price signals have been utterly destroyed by cartel behavior, leading to an endlessly growing bureaucracy making bespoke decisions about what's "approved". HMOs and provider "networks" should be illegal (straightforward antitrust), every provider should be made to publish straightforward prices (uniform regardless of who's paying), and coverage/copayments should be based only on price. Only then will the market be able to right itself, and develop administrative structures that revolve around providing patient care rather than policing access to it. The insurance offerings that cover expensive conditions will then end up looking similar to the LTC/life insurance market, rather than this fallacious game of musical chairs that we play every year during "open enrollment". Subsidies for people who can't pay for what they need is an orthogonal topic, and funding for such can only come from the government or private charity. The current system tries to bundle it all together while hoping that corporate charity will magically arise, when the obvious incentive is for health "insurers" to take all the money they can from healthy people, and then drop them once they get sick.