zInsurance Prior Authorization Template

The word documents provided on this website are intended to be used as templates to justify medical necessity when requesting prior authorization for insurance coverage of genetic testing.  The documents will require modification for your patient.  Using these templates does not guarantee approval of insurance coverage.  We will continue to add additional templates as they are developed.  Testing labs often provide Letters of Medical Necessity on their websites as well.

We recommend genetic counseling prior to testing that includes:  the reason for testing, what is (and is not) being tested, possible outcomes and their meaning, and the benefits and limitations of testing.

Note: When completed, these documents will contain Protected Health Information.  Follow your institutional HIPAA guidelines when using this document.