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Alzheimer's Disease:
Experimental Treatments (
http://www.aetna.com/cpb/medical/data/700_799/0788.html
)
http://www.aetna.com/cpb/medical/data/700_799/0788.html ( http://ww
w.aetna.com/cpb/medical/data/700_799/0788.html )

Aetna considers the following treatments for Alzheimer's disease

(AD) experimental and investigational because their effectiveness
for this indication has not been established (not an all inclusive
list).

Alzheimer's Disease:
Experimental Treatments (

http://www.aetna.com/cpb/medical/data/700_799/0788.html
)
http://www.aetna.com/cpb/medical/data/700_799/0788.html ( http://ww
w.aetna.com/cpb/medical/data/700_799/0788.html )

Aetna considers the following treatments for Alzheimer's disease

(AD) experimental and investigational because their effectiveness
for this indication has not been established (not an all inclusive
list).

Alzheimer's Disease:
Experimental Tests (
http://www.aetna.com/cpb/medical/data/300_399/0349.html
)
http://www.aetna.com/cpb/medical/data/300_399/0349.html ( http://ww
w.aetna.com/cpb/medical/data/300_399/0349.html )

Individuals & Families (/individuals-families.html#open)

Aetna considers the following tests/measurements experimental

and investigational for the diagnosis and assessment of persons
Employers & Organizations (/employers-organizations.html#open)
with Alzheimer disease and related dementias because their
clinical value remains unproven for this indication:

Health Care Professionals (/health-care-professionals.html#open)

Producers (/insurance-producer.html#open)

Alzheimer's Disease:
About
Us (/about-us.html#open)
Experimental
Tests (
http://www.aetna.com/cpb/medical/data/300_399/0349.html
News & Analysis (http://news.aetna.com/)
)
http://www.aetna.com/cpb/medical/data/300_399/0349.html ( http://ww
w.aetna.com/cpb/medical/data/300_399/0349.html )

Aetna considers the following tests/measurements experimental

and investigational for the diagnosis and assessment of persons
with Alzheimer disease and related dementias because their
clinical value remains unproven for this indication:

Genetic Testing (
http://www.aetna.com/cpb/medical/data/100_199/0140.html
)
http://www.aetna.com/cpb/medical/data/100_199/0140.html ( http://ww
w.aetna.com/cpb/medical/data/100_199/0140.html )

In the absence of specific information regarding advances in the

knowledge of mutation characteristics for a particular disorder,
the current literature indicates that genetic tests for inherited
disease need only be conducted once per lifetime of the
member.

Genetic Testing (
http://www.aetna.com/cpb/medical/data/100_199/0140.html
)
http://www.aetna.com/cpb/medical/data/100_199/0140.html ( http://ww
w.aetna.com/cpb/medical/data/100_199/0140.html )

In the absence of specific information regarding advances in the

knowledge of mutation characteristics for a particular disorder,
the current literature indicates that genetic tests for inherited
disease need only be conducted once per lifetime of the
member.

Obstructive Sleep Apnea in Adults

(
http://www.aetna.com/cpb/medical/data/1_99/0004.html
)
http://www.aetna.com/cpb/medical/data/1_99/0004.html ( http://www.a
etna.com/cpb/medical/data/1_99/0004.html )

Aetna considers the diagnosis and treatment of obstructive sleep

apnea (OSA) in adults aged 18 and older medically necessary
according to the criteria outlined below.

Positron Emission Tomography

(PET) (
http://www.aetna.com/cpb/medical/data/1_99/0071.html
)
http://www.aetna.com/cpb/medical/data/1_99/0071.html ( http://www.a
etna.com/cpb/medical/data/1_99/0071.html )

In these cases, the PET scan must have been considered

necessary in order to determine what medical or surgical
intervention is required to treat the member.

Urinary Incontinence Treatments (

http://www.aetna.com/cpb/medical/data/200_299/0223.html
)
http://www.aetna.com/cpb/medical/data/200_299/0223.html ( http://ww
w.aetna.com/cpb/medical/data/200_299/0223.html )

Aetna considers the implantation of an artificial urinary sphincter

(AUS) medically necessary for the treatment of urinary
incontinence (UI) due to intrinsic urethral sphincter deficiency
(IUSD) for members with any of the following indications:

HMO California (
http://www.aetna.com/data/disclosures/hmo_CA.pdf
)
http://www.aetna.com/data/disclosures/hmo_CA.pdf ( http://www.aetna.
com/data/disclosures/hmo_CA.pdf )

THIS DISCLOSURE FORM IS ONLY A SUMMARY.* * THE EVIDENCE

OF COVERAGE CONTAINS THE TERMS AND CONDITIONS OF
COVERAGE AND SHOULD BE CONSULTED TO DETERMINE
GOVERNING CONTRACTUAL PROVISIONS. * * YOU HAVE A RIGHT
TO VIEW THE EVIDENCE OF COVERAGE PRIOR TO ENROLLMENT
IN THIS PLAN.

Copyright 2001-2014 Aetna Inc.

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