If you fail to run the gauntlet, or give up in frustration, the insurance company doesn’t have to pay. They could absolutely make this process easier, but the incompetence works in their favor.

I’ve lived in single payer countries as well as in the US, and the incompetence is the same everywhere. In my experience the big difference is in universal healthcare countries the rules are very strictly defined and there’s very little scope for exceptions, so either you qualify or you don’t. The other issue is that even if you qualify there’s often a multi-month waiting list for treatment.

And they keep all their powdered sugar in these little baggies.