[DATE]
Patient: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
Insurance Company: [INSURANCE_COMPANY_NAME]
Subscriber Name: [POLICY_HOLDER_NAME]
Policy #: [POLICY_NUMBER]
Dear Claims Specialist,
I am writing this letter on behalf of my patient [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME] to request coverage for the OncoGeneDx Lynch/Colorectal High Risk panel, a genetic test offered through GeneDx, a high complexity CLIA certified laboratory located in Gaithersburg, Maryland.
Personal and Family History:
[PATIENT_FIRST_NAME] is a [PATIENT_AGE] year-old [PATIENT_GENDER] suspected to have hereditary predisposition to colorectal cancer. [MR./MS.] [PATIENT_LAST_NAME] was diagnosed with XX cancer at age XX years. [HIS_HER] family history is remarkable for (discuss family history). [MR./MS.] [PATIENT_LAST_NAME]’s (personal and/or family) history is suggestive of a diagnosis of hereditary colorectal cancer. However, the only way to thoroughly assess this patient’s future cancer risks is to perform genetic testing. The results of this genetic test will have a direct impact on this patient’s treatment and management.
Test Information and Impact of Results on Medical Management:
As you are aware, multiple genes are associated with hereditary colorectal cancer. The OncoGeneDx Lynch/Colorectal High Risk panel includes analysis of seven genes affecting colorectal cancer risk. Panel testing utilizes next generation sequencing technology, which allows for analysis of multiple genes simultaneously. This is far more cost effective and timely than stepwise genetic testing (for example, ordering testing of one or two genes followed by additional genetic tests, if negative).
An additional benefit of the OncoGeneDx Lynch/Colorectal High Risk panel is the ability to test for multiple hereditary cancer syndromes at once. Many hereditary colorectal cancer pedigrees display significant phenotypic overlap with those of other hereditary cancer syndromes. For example, multiple colorectal polyps may be present in a family with Lynch syndrome, Familial Adenomatous Polyposis (FAP) or MUTYH-Associated Polyposis (MAP). A hereditary cancer syndrome diagnosis cannot always be established based upon the pedigree analysis alone. The OncoGeneDx Lynch/Colorectal High Risk panel tests for genes associated with multiple hereditary cancer syndromes that may present similarly, including Lynch syndrome, FAP/attenuated FAP and MAP. While Lynch, FAP and MAP syndromes are all associated with significantly increased risks of colorectal cancer, each syndrome has gene-specific and site-specific cancer risks for which National Comprehensive Cancer Network (NCCN) management recommendations differ1. These may include increased cancer surveillance and options for prophylactic surgeries and chemoprevention. Thus, it is essential that an accurate diagnosis is established for this patient in order to determine [HIS_HER] appropriate medical management.
Conclusion:
Knowledge of this patient's genetic information is important for me to more accurately assess [HIS_HER] cancer risks and will guide my recommendations for [HIS_HER] care. I am specifying GeneDx because this laboratory has highly sensitive, rapid and cost-effective genetic testing for hereditary colorectal cancer.
Thank you for your review and consideration. I hope you will support this request for genetic testing coverage for [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]. If you have questions, or if I can be of further assistance, please do not hesitate to call me at [PHYSICIAN_PHONE_NUMBER].
Sincerely,
[PHYSICIAN_FIRST_NAME] [PHYSICIAN_LAST_NAME], MD
cc: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/Familial High-Risk Assessment: Colorectal. Version 2.2014. www.nccn.org.