One thing lost on people is the "for-profit" motive is not solely with insurers or plan providers. Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.

This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible.

I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.