When I was working as a Physician one of the Pharmaceutical Representatives told me his previous job was at Cigna. He and his colleagues were incentivized to deny claims or authorizations for tests/procedures by using whatever pretense they could make up off the top of their heads. As a Physician who would have to spend hours arguing with these completely absurd people I believed him implicitly. I think he got $50 for every $1000 in services that he successfully denied (this was in the late nineties). It was a lark for him , first job out of college, sit around and make up nonsense and get paid for it. Ultimately when he saw an elderly relative being denied treatment with the same tactics he regretted his efforts and changed careers.
Insurance companies don’t make money by paying claims. Duh