Can Health Insurance legally provide different coverage from what is in the policy documents given to policyholder?

I'm running into this for Aetna.

I was undergoing physical therapy at a physical therapy department of a hospital. According to my insurance coverage, it should be copay only with deductible waived. But Aetna billed it at full deductible, and then a % after deductible is met.

My issue is that the Aetna website Medical Coverage page for physical therapy doesn't mention this distinction. It only mentions the copay and that deductible is waived. Then when I go into the more detailed 32-page Benefits Overview doc, or the 125-page Benefit Plan Description doc, it also does not break down that the coverage is different for physical therapy in a hospital setting.

There ARE services like 'infusion therapy' where if the coverage is different based on where it is performed, it is clearly broken down in the table with the coverage level for each setting. For Physical Therapy, it just mentions copay and deductible waived and no breakdown provided.

So now I'm stuck where the insurance is insisting on a set of coverage conditions that are not mentioned in their plan documents that I thoroughly read when I signed up. If I appeal, the agent told me even if they cover the first visit on copay and waived deductible, they won't cover future physical therapy claims. But when I signed up for the full year, I signed up based on the plan documents.

Can Insurance just change plan coverage documents with different conditions mid-way through the year? Is that Legal?

submitted by /u/sher_scrabblistani
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