I think the stated goal should be that if you take the money (premiums) then you pay the bill.
The patient and Dr will determine the treatment and the insurance company will pay the bill. Not pre-approval or anything else.
If a Dr or hospitals or big pharma are defrauding the insurance company then take it up with them in court.
The patient should get treatment period! It should be 100% with no copay or any other machinations devised by these companies.
This doesn't have to be hard if you just follow the stated goal and hold Dr, hospitals, big pharma and insurance companies accountable for doing their best to make the patient whole.