Exclusions differ in summary plan text vs. full plan text

Exclusions differ in summary plan text vs. full plan text

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.

Screenshots: https://imgur.com/a/kmvxZU7

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!

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