I've never known a claim by me or my now-ex wife or kid to be rejected in a way that mattered. A time or two a doctor had to provide additional information but the treatment/etc. was covered. And when overlapping prescriptions occurred the older one wasn't filled (sometimes yes, sometimes no--I take liothyronine and managed to accidentally accrue an extra 3-months' supply).
Sometimes it was on short notice. I go to a doctor, said doc vanishes for 15 minutes and comes back to ask a few questions then tell me that I will be leaving her office, crossing the street, and checking into the hospital for a week or more.
Now, I also self limit. As did my kid and ex-wife. "You have seborrhea, I'd like to prescribe X and Y and have you see a dermatologist." "Really? I have seborrhea? It hasn't been a problem, in fact I haven't noticed anything." "So you are saying no to treatment." "Well, yeah." Doc wants me on medication for pre-diabetes, except that she's pushed that for the last 3-4 years and I'm still not actually pre-diabetic, even though they've lowered the guidelines. Others I know are relieved to be spared the horrors of ... whatever.
One doctor had no problem getting me CAT-scanned and under radiation therapy for an off-the-books treatment for tissue growth in the eye sockets as a result of Graves disease. (Usually they, at the time at least, would yank out the eyeballs and scoop out the excess tissue, then re-anchor said eyeballs; instead I got to experience a gamma knife first hand, like a cancer patient; it worked and I had a small out-of-pocket co-pay.)
Then again, I had pretty good insurance coverage. My current coverage has a gaping donut hole. I lapse into it and lots of things aren't covered. Probably next year I'll reduce the donut hole, pay a lot more for better coverage, and have a small raft of things that would push me deep into that unmitigated hole dealt with.
= new reply since forum marked as read