The OUTCAN folks have to deal with MSH, which is the issue. Canada Life has been fine for my spouse.
I know of someone who had to pay upfront (still waiting on reimbursement) in the US for the birth of their child. It’s been a few months.
Let’s just say the price they had to pay was absolutely shocking and I have no idea how people without huge amounts of insurance can afford literally having a baby there. Hell, I’m not sure how they’re financially afloat even with the allowances, after that invoice.