Download LOMN - GeneDx

[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 Custom 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 a hereditary predisposition to 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
hereditary cancer syndrome. 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, numerous genes and cancer syndromes are associated with hereditary cancer. The
OncoGeneDx Custom panel can include analysis of highly penetrant genes affecting 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 Custom panel is the ability to test for multiple hereditary
cancer syndromes at once. Many hereditary cancer pedigrees display significant phenotypic overlap
with those of other hereditary cancer syndromes. For example, several cases of endometrial cancer
and colorectal polyps may be present in a family with Lynch syndrome (associated with mutations in
MLH1, MSH2, MSH6, PMS2 and EPCAM) or with Cowden syndrome (associated with mutations
in PTEN). Multiple cases of ovarian cancer may be present in a family with Lynch syndrome or
hereditary breast/ovarian cancer syndrome due to a BRCA1 or BRCA2 mutation. A hereditary
cancer syndrome diagnosis cannot always be established based upon the pedigree analysis alone. The
OncoGeneDx Custom panel allows the healthcare provider the ability to select one or more genes
that are associated with multiple hereditary cancer syndromes that may present similarly, including
Lynch syndrome, Cowden syndrome, Li-Fraumeni syndrome, hereditary breast/ovarian cancer
syndrome, hereditary diffuse gastric cancer, Peutz-Jeghers syndrome and others. While each of these
syndromes is associated with a significantly increased risk of cancer, each syndrome has genespecific and site-specific cancer risks for which National Comprehensive Cancer Network (NCCN)
management recommendations differ1,2. 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 have chosen to
send the patient’s test to GeneDx because this laboratory has highly sensitive, rapid and costeffective genetic testing for hereditary cancer syndromes, which will provide helpful medical
treatment planning information for my patient.
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: Breast and Ovarian. Version 1.2015. www.nccn.org.
2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/Familial
High-Risk Assessment: Colorectal. Version 2.2014. www.nccn.org.