Thinking of trying the PILLAR PROCEDURE. Anyone tried it?

Upon individual review, positive airway pressure devices are considered a medically necessary form of noninvasive ventilation for members with lung disease without OSA. Requests for these devices for noninvasive ventilation of members with lung disease are subject to medical review.

Uvulopalatopharyngoplasty (UPPP)
Uvulopalatopharyngoplasty is used to treat OSA by enlarging the oropharynx; it is considered medically necessary for OSA members who meet the criteria for CPAP (see above), but who are intolerant to CPAP. The medical records must document that the member has attempted CPAP before considering surgery.

Uvulopalatopharyngoplasty has been found to be most reliably effective in OSA members who have adequately responded to a trial of CPAP. If CPAP is unsuccessful in relieving a member's symptoms, Aetna considers this procedure experimental and investigational because this surgical approach has not been shown to be effective in non-obstructive apnea.

Uvulectomy and Laser Assisted Uvuloplasty (LAUP)
Cold knife uvulectomy and laser assisted uvuloplasty (LAUP, laser uvulectomy) are considered experimental and investigational because they have not been shown to be as effective as UPPP in the treatment of OSA. However, Aetna may consider these procedures medically necessary, upon individual case review, for members with severe OSA who have other medical conditions that make them unable to undergo UPPP and have failed a trial of CPAP or the use of an oral appliance or device. Note: According to available literature, persons who undergo uvulectomy or LAUP should have a follow-up sleep study to assess the results of the procedure.

Somnoplasty and Coblation
Aetna considers radiofrequency ablation of the tongue base, uvula or soft palate (Somnoplasty) or of the nasal passages and soft palate (Coblation) experimental and investigational as a treatment for obstructive sleep apnea because there is inadequate scientific evidence to validate the effectiveness of these procedures for this indication. Please see CPB 592 - Radiofrequency Ablation of Hypertrophied Nasal Turbinates.

The Repose System
Aetna considers the Repose system, a minimally invasive technique involving tongue base suspension, experimental and investigational. This procedure has been used for treating sleep disordered breathing (SDB) caused by tongue base collapse. No specific criteria exist regarding the diagnosis of tongue base collapse in SDB. Preliminary short-term studies of surgery targeted to alleviate tongue base collapse in SDB have shown subjective improvements in snoring and statistically significant decreases in mean RDI. However, the reported rates of success have been inconsistent among studies, and larger controlled studies with long-term follow-up are necessary to determine whether the Repose system is safe and effective.

Pediatric Obstructive Sleep Apnea Syndrome (OSAS): Tonsillectomy and Adenoidectomy
Aetna considers tonsillectomy and adenoidectomy medically necessary for treatment of obstructive sleep apnea in children. Childhood OSAS is usually associated with adenotonsillar hypertrophy, and the available medical literature suggests that the majority of cases are amenable to and will benefit from tonsillectomy and adenoidectomy.

Jaw Realignment Surgery (i.e., hyoid myotomy and suspension, mandibular osteotomy, genioglossal advancement)
Aetna considers jaw realignment surgery medically necessary for persons who fail other treatment approaches for OSA.

Although jaw realignment surgery may be considered medically necessary on an individual case basis, because of the extent of surgery, these cases may be subject to review by Aetna's Oral and Maxillofacial Surgery Unit to assess medical necessity.

Note: According to the medical literature, persons undergoing jaw realignment surgery must usually also undergo orthodontic therapy to correct changes in occlusion associated with the surgery. Orthodontic therapy (i.e., the placement of orthodontic brackets and wires) is excluded from coverage under standard Aetna medical plans regardless of medical necessity. Please check benefit plan descriptions for details. Benefits for orthodontic therapy may be available under the member's dental plan, if any.

Tracheostomy
Aetna considers tracheostomy medically necessary for those members with the most severe obstructive sleep apnea not manageable by other interventions. Requests for tracheostomy for OSA are subject to medical review.

Cardiac (Atrial) Pacing
Aetna considers cardiac (atrial) pacing for treatment of sleep apnea experimental and investigational because the effectiveness of this procedure for obstructive sleep apnea has not been established.

Injection Snoreplasty
Aetna considers injection snoreplasty, injection of a sclerosing agent into the soft palate, experimental and investigational for the treatment of obstructive sleep apnea because its effectiveness for this indication has not been established. Treatment of snoring alone, without significant OSA, is not considered medically necessary

Cautery-Assisted Palatal Stiffening Operation (CAPSO)
Aetna considers cautery-assisted palatal stiffening operation (CAPSO) experimental and investigational for the treatment of OSA because its effectiveness for this indication has not been established.

Pillar™ Palatal Implant System
Aetna considers the PillarTM Palatal Implant System (Restore Medical, Inc.) experimental and investigational for the treatment of OSA because its effectiveness for this indication has not been established.