Hi all, I had been excited to switch to my company’s Cigna PPO plan in prep for orthognathic (jaw) surgery next year. I absolutely meet the definition of medical necessity due to a severe anterior open bite.
However, I’ve come to learn a lot of plans exclude orthognathic surgeries regardless of clinical indication. Sure enough, I’m seeing this exclusion in the summary plan text… but NOT in the full plan text — it is left out of the very same exclusions paragraph.
Since the summary plan document states at the end “If there are any differences between this summary and the plan documents, the information in the plan documents takes precedence” — this should mean it will be covered for me right? I climbed the chain through my HR and spoke to a seemingly very knowledgable Cigna rep who confirmed when I pointed this out, but I would still like opinions on how hard this fight could potentially be for me.
I also cannot believe how extremely difficult it was to get a copy of the full plan text. Should be massively illegal.
Thank you for any thoughts or insights!