Insurance companies in the US often exhibit paradoxical behavior based entirely on statistics and ignoring individual case details.

Often a less expensive procedure will be denied until after a more expensive procedure is performed, guaranteeing that insurance has to pay for both, just because some significant percent of patients need the more expensive procedure either way.

Health insurance is utterly stupid, and mainly because it’s a for-profit, private enterprise in the US. Data goes in and a decision comes out, and the insurance companies really only care as long as the algorithm results in a net profit over time. Good outcomes for patients isn’t even a consideration.