United won’t give me full health insurance plan docs

This seems so wrong. Is it legal? The issue arose because I'm going through IVF. The summary of coverage book I got from my employer says that genetic testing of the embryos will be covered if ordered by my doctor after a genetic consult. So both things happened. Doctor also submitted a standard pre-approval for many IVF-related claims, including an embryo biopsy for genetic testing, assuming that covered his portion of tasks relevant to the testing. And that the lab would submit the documentation for the actual genetic testing. But the lab didn't send a pre-approval (or know they needed to either). And now insurance is denying the claim ($3,000) because there was no pre-approval, even though that's nowhere mentioned in my summary of benefits guide. I asked them to send me the full policy. And they did send me the specific paragraph that applied to this, but are refusing to send me the full policy.

I am sure it's probably legal or so many people wouldn't be so adamant about not giving it to me, but it seems absurd to pay for something and not be entitled to the full contract of what you're paying for. Especially when not having that document directly results in not getting coverage a little more information would have enabled me to qualify for. If there is a way to get this documentation (they just direct me back to my company for the less comprehensive doc), could someone let me know? So annoyed that not knowing one tiny procedural loophole means I'm out $3k, and would really like to avoid that going forward.

See also  Payment snafu

submitted by /u/Electrical_Sleep5376
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