Clinical Trials, Coverage of Routine Patient Care Costs

Aetna covers medically necessary routine patient care costs and medically necessary treatment of unexpected complications for members in qualifying clinical trials, but excludes protocol‑induced data collection/record‑keeping costs and remains subject to plan exclusions and out‑of‑network limits. Coverage requires a written, scientifically sound trial protocol with prior IRB approval, and members/providers must comply with all applicable plan utilization management rules, precertification/registration/referral requirements (Aetna may request trial documentation); limited Category B/terminal‑illness investigational device exceptions may apply per plan.

"Medically necessary routine patient care costs in clinical trials are covered in the same manner as routine care for members not in clinical trials."

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