The difference here is that oftentimes your situation can markedly deteriorate, sometimes irreversibly, as a result of that denial. And the "make a stink" can come at a time you're least equipped to deal with it.

> It's all negotiation. They put forth an initial low-ball offer because most people accept it.

And that's the problem. People having to make a stink because insurers are doing things that are in contradiction to the policy they wrote, if not the law, because private enterprise wants more money.

Private enterprise that has simultaneously almost singlehandedly caused the skyrocketing of medical costs, because the only way to make more money when your profits are regulated is to increase costs, and nobody except the consumer/patient is incentivized to do anything about it, quite the opposite - they're entirely happy to go along with it. And then insurers will stand up in Court and say "Oh, we're not denying care to our customer, we're just saying we won't pay for it. They're free to pay for it out of pocket." My old boss would have received a $1.8M bill for his daughter's care, born at 33 weeks. A coworker of mine had to raise a substantial portion of an expected $1.25M bill for a lung transplant for her son. My kidney stone would have cost $70,000 to have not been resolved (they went in, found infection, retreated and gave me IV antibiotics instead, and revisited the issue two weeks later, which had its own separate bill). My ENT had to put me on two expensive and useless nasal sprays for months so that when he recommended deviated septum surgery for an effectively blocked nostril (90%+ deviation) that insurance wouldn't deny it because (gasp, shock, horror) nasal sprays don't realign or open up cartilage.

Exactly. You shouldn't have to lift a finger to negotiate with a company where there is a written agreement that they owe you money or that you are entitled to a claim or similar.

This whole "you have to haggle for everything" culture we're putting together stinks.