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 Rest of Comprehensive
Cancer 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, multiple genes and cancer syndromes are associated with hereditary predisposition
to cancer. The OncoGeneDx Rest of Comprehensive cancer panel includes analysis of other highly
penetrant genes affecting cancer risk after testing of a smaller subpanel of genes has been
uninformative. 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 Rest of Comprehensive Cancer 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 Rest of Comprehensive Cancer panel
tests for genes that are included in the Comprehensive Cancer panel that have not yet been
evaluated for a particular patient. The genes included on the panel 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 gene-specific 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.