Covered or Not?

Here's an article about a private health insurer and how they dealt with an out-of-network referral. I'm still trying to figure out how you know what you're getting with health insurance. Some of it sounds like the coverage is great, but when a patient needs a service or goes to get a medicine, it's not covered. The one good thing about HMO's is that there is no pretense: you know you're not getting out-of-network care, you know the formularies are limited. This is from the wife of a cancer patient and the struggles they had getting the care:

http://seattletimes.nwsource.com/html/opinion/2009685301_harrop19.html