P1: GDW Journal of Genetic Counseling [jgc]


January 7, 2002


Style file version Nov. 19th, 1999

C 2002) Journal of Genetic Counseling, Vol. 11, No. 1, February 2002 (°

Letter to the Editor

INSURANCE JUSTIFICATION LETTERS The article by Shappell and Matloff entitled “Writing Effective Insurance Justification Letters for Cancer Genetic Testing: A Streamlined Approach” (J Genet Counsel 10:331–341 (2001)) was well written, insightful, and will be a useful resource for genetic counselors, medical geneticists, and other health professionals. Few health plans employ medical directors, nurse case managers, or patient management utilization staff with formal training in genetics. The Shappell and Matloff article provides a mechanism for educating our colleagues in other medical disciplines. The format outlined by the authors clearly and concisely illustrates why genetic testing is clinically relevant for the management of the particular patient referenced in the letter. In addition to encouraging those who write letters to summarize the genetics issues concisely, I recommend including two key pieces of information that are helpful in determining eligibility for insurance coverage. These recommendations apply to all requests, not just those related to cancer genetics. 1. Include specific information about why the requested service is important for the immediate clinical management of the patient, and how the clinical management will be changed based upon the results of the test (e.g., how DNA results would change the frequency of colonoscopy in a person at risk for hereditary nonpolyposis colon cancer). 2. Add references in support of your request, such as policy statements of American College of Medical Genetics, results of randomized trials, or articles from prominent peer-reviewed journals. I encourage all readers to keep this useful reference handy. Utilizing the guidelines outlined in the article will help ensure that patients receive adequate insurance coverage and make my work—and that of my counterparts in other health plans—much easier. Allan T. Bombard, MD, FACMG Department of Obstetrics and Gynecology & Women’s Health Albert Einstein College of Medicine/Bronx, New York And Women’s Health / Western U.S. Aetna, Inc./San Ramon, California 75 C 2002 National Society of Genetic Counselors, Inc. 1059-7700/02/0200-0075/1 °

Letter to the Editor: Insurance Justification Letters.

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