Years ago, my father had an employee who was never sick a day in his life and was employed with him for years. One day he had a heart attack. He wasn’t that old either. Blue Cross/Blue Shield wanted to pay $7.95. Enough said except my father never used them again.
Was it a PPO policy?
What was the patient responsibility?
If they hadn’t met the deductible, benefits usually are not available. It may also have been subject to a pre existing waiting period.
If they went in or out of network would also be a factor.
If it was a PPO policy and deductible and out of pocket expense was met, and they went in network, it would generally be covered at 100%
Sounds like an Allstate Home Owners Insurance settlement for a total loss.