Depending on the plan there are state insurance regulators you can appeal to who basically have the final say but I agree, the random denials etc... it's like the do it on purpose. There is also an appeal window of like 60 days in most cases so the best thing someone can do to help is help your family member manage and file appeals/paperwork as necessary. You can also find former insurance company employees who act as patient advocates and know who and how to call to get things done. A lot of them work at hospitals but you can find them outside as well. Sometimes your insurance will have a patient advocate. They are actually on your side and will help.