We might all need to remember that insurance companies exist as companies to make money. Most have shareholders and investors.
Hence, they use actuarial analyses and tables to define and limit their exposure for payments. If they paid out a dollar or euro for every dollar or euro collected in premiums, they would soon go bust. Their profits are in the difference between collected premiums, minus payments and administrative expenses.
This difference is the actuarial gambit or gamble. This is why they do not cover the more hazardous activities that are more likely to attract expensive medical or related costs.
I am NOT defending insurance companies. All I am trying to explain is that they are there to provide a backstop in the event of a statistically rare incident which will generate significant costs. They are not there to cover 100 percent of your expenses. That is why you have deductibles on insurance cover for automobiles, boats, and homes.
Also, and to further explain this context, until around 1980, most countries with a private insurance market for health care, only offered what was called "major medical" for procedures that you actually had to check into a hospital for. YOU were expected to pick up out of pocket costs for office visits, prescribed medications and diagnostic tests.
With medical advances, improvements in diagnostic tests, advances in medication and more procedures being done as outpatient / same day surgeries and the proliferation of medical specialists, it became necessary to change how health insurance was provided. When these changes came, individuals could not possibly bear the out of pocket costs.
Now, most folks expect their insurance cover, for anything, to pay for everything. Just sayin...
Hope this helps the discussion.
