I don’t think we should trust the soundness of their algorithm. I’ve worked in the healthcare space before, and the perverse incentives involved should make everyone extremely skeptical of insurance companies’ motivations, procedures, and algorithms.
From the description it sounded like something trivial. E.g. given the diagnosis, there might be a cheaper known way to get to it. I am a layman, but for instance that could be ordering an MRI when an ultrasound would suffice.
