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So... Your Personal Healthcare Advocate has introduced you to the DNA test which will help ALL of your health care providers customize your medications... for the rest of your life!
Now, we'll discuss how to successfully approach your provider to order the test...
Also, your Personal Healthcare Advocate could accompany you to smooth the process in introducing this to your health care provider, but only if appropriate to your situation.
[Note to Personal Healthcare Advocates: print the forms suggested below and include them in the packet you will provide to the patient.]
Quick Links below:
Two Ways to do this... Pick One!
Two Ways to do this... Pick One!
Option 1: Incredibly easy path...
Option 1: Incredibly easy path...
If you just want to hand a package to the provider, you can do so... but with some providers, they may be less prone to agree to order the test, so also strongly consider taking a little more effort to advocate on your part with option 2 below.
Still want to go the easy route? Visit this page:
Option 2: You as Your Own Health Care Advocate
Option 2: You as Your Own Health Care Advocate
The rest of this page is for that option...
First and foremost, this is YOUR health, and hopefully your provider will respect that you are taking command of your own health care.
You'll go into the visit with the test swab kit and a few forms which I'll discuss below.
Option 2 will take a little more homework on your part, but as your own health advocate, this effort is worthwhile since you will only need to take this test one time in your life and you'll get lifetime benefits from it!
Prepare Your Rationale Statement to Your Provider
Prepare Your Rationale Statement to Your Provider
Your health care provider might be quite receptive to ordering a DNA test for you... my doctor was and I think most will be. However, you should be prepared that your provider may be hesitant, because they just haven't kept up with new developments as much as they should, so you need to:
(a) provide a concise but convincing rationale, and...
(b) make it as easy and as quick as possible, and with the least amount of paperwork you will hand to the provider.
You will explain very briefly what the test is, why you want it ordered with a rationale statement like this (customized to your style and health condition):
"I want to be tested with this DNA test pioneered by the Mayo Clinic.
It will help you and my other doctors determine how my body will (or will not) metabolize certain drugs, based on my unique, personal genetic blueprint.
That way, all my drugs can be fine-tuned by ALL of my doctors to my DNA profile...
... and this particular lab is the only lab that will be updating new drugs as applied to my profile every single day for the rest of my life with future drugs not even available today, so I won't ever have to take the test again when I develop new health conditions.
And most insurance companies pay 100% for the test!"
If your provider asks about the lab, you could add this:
"This lab has been conducting forensic DNA tests for the U.S. Government for over 20 years. It is only one of three labs in the country that are approved by the Veterans Administration for DNA testing."
(To help you create your own statement, I included further down my own personal rationale statement I expressed to my own doctor.)
Or you can use this "Talking Paper" to review in the waiting room and refer to it during your discussion with your provider (also linked above):
Will Your Insurance Cover the Cost?
Will Your Insurance Cover the Cost?
Below are two sections extracted from the Pharmacogenomics (PGx) test page:
- How Do I Know If I Qualify For A PGx Test?
"There are many ways to qualify for a PGx test. You qualify if you are taking multiple medications or even a single medication that is identified by the FDA as a drug requiring a PGx test prior to being prescribed...
... The following website lists over 250 drugs with pharmacogenomic information in their labeling, along with requirements and FDA recommendations:"
- How Much Will The PGx Test Cost Me?
"Genetic testing is considered preventive care. Insurance will typically cover the entire cost of the test if you meet the medical necessity requirements, so there would be no out of pocket costs for you in most cases.
The lab will check with your insurance company to make sure they will cover the test. If your insurance company will not approve the test, or not agree to cover the entire cost, the lab will contact you with further options. Again, they will not automatically process the test and hold you responsible for the cost.
Testing is also available for those who are uninsured and/or those who wish to self-pay for the test. Please check with your genetic screening advocate or medical provider for further details on pricing."
That self pay option would cost $300.
Before Making Your Appointment
Before Making Your Appointment
Decide Which Health Care Provider
Decide Which Health Care Provider
You may decide to approach the very next provider with whom you have an appointment, but maybe they might not be the best choice.
Factors to Help You Choose:
- Your primary care physician or nurse practitioner is the overall "orchestrator" of your health care... usually they would be the best choice.
- If you are taking high doses of pain medication or psychiatric drugs, these are potentially the most dangerous and could more easily be involved in an adverse drug reaction with your other drugs. Your pain doctor or psychiatrist may be your best choice.
- Whichever provider prescribes the most medications for you.
- Any provider who has prescribed medication that had to be adjusted over time due to insufficient results or an adverse drug reaction.
What if my Provider Balks?
Some providers are set in their ways. If the provider you approach doesn't want to order the test, you ask, "Why?" And if they give you a weak reason, you could then approach one of your other providers...
And you could think about switching doctors! (Do they really have your health in mind? Do the want you to feel you are getting the best health care possible?)
Prepare to Make it Eaaaasy for the Provider to Say Yes!
Prepare to Make it Eaaaasy for the Provider to Say Yes!
We want to make things as smooth and easy as possible for the provider, and to have everything in hand and partially filled out, which signals that you're expecting this to happen!
You'll notice in the sequence below -- from handing the provider only two pages -- Test Request Form to make entries on pages 1 and 3 -- all the way to sending two videos after the appointment...
We are slowly layering information at the right pace...
...Not too much, not too little, but juuuuuuust right!
Then the provider or their staff can collect saliva samples from you. After a few more steps discussed below, you'll be finished...
... You will have gotten your test ordered, now you can exit "stage right" with minimum fuss.
Prior to the Day of the Appointment
Prior to the Day of the Appointment
Familiarize Yourself with Kit Contents
Familiarize Yourself with Kit Contents
- Saliva testing swabs
- The FedEx Express folder and prepaid AirBill
Note: See the Shipping section at the bottom of this page. Have your healthcare advocate review the entire package and then that advocate will send it to the lab.
Familiarize yourself with the steps so you can be sure the provider or their staff completes all the steps.
(Or your Health Care Advocate can perform the swab test and complete the paperwork, after the provider signs the three forms.)
(p.1) Test Request Form:
Complete the Patient Information and Insurance Information sections at the top.
(p.2) Genetic Testing and Billing Informed Consent:
Read, sign, print your name and date.
(Note: The provider will not need to sign that form so you won't even be handing that one to the provider.)
(p.3) Additional Information for Insurance Coverage:
I suggest studying the page and checking in light pencil in the margins (or PostIt Notes) for the items you think apply to you so you can point those out to the provider.
Important additional form which your Health Care Advocate may have given you for the provider to sign if it's the first time your provider has used this lab: Clinical Report User Authorization form, discussed below.
You'll want to be prepared to present your request to the provider in a respectful but firm way, that shows you want this test, and you're expecting a "yes" from them!
Therefore, review the sequence below and practice the rationale statement suggested above (Another version is further down... it's what I told my own doctor.).
Read it out loud, then adjust it to your own style and for your particular health situation.
Additional Documents your Advocate May Have Given You
Additional Documents your Advocate May Have Given You
These forms may have been given to you by Personal Healthcare Advocate, depending on your circumstances. If not, skip to the next section.
- Clinical Report User Authorization Form
- This gives your provider access to the website portal which contains your DNA test. This is not necessary if the provider has already been given access from a prior request. But if this is the first time your provider has used this lab, it will be required. Your health care advocate will send this separately, prior to sending the kit to the lab.
- PGx Test Request Letter - Not necessary if you're going to verbally state your rationale yourself (which I strongly suggest). But if you prefer to have this letter speak for you, it certainly can.
[Note: If you wish, you can use this "talking paper" discussed above: My Request for Pharmacogenomics Test.]
Even if you plan to provide your own rationale, this letter can be a good refresher for you to review, right before expressing that rationale.
Then, after your state your case, you can point to the four sub-bullets in that letter ("And these four points explain how the test will help you to help me!"),,,
> Help maximize drug efficacy specifically for me
> Help minimize or prevent adverse drug reactions/events for me
> Help you prescribe the right drugs, at the right doses, at the right times for me
> Alert you to Drug-to-Drug, Drug-to-Food, Drug-to-Alcohol, and Drug-to-Lab-Interactions that could affect me
- PGx Medical Necessity/Med List - This very helpful document discusses which patients benefit most from PGx testing according to health condition, which drugs they are taking, etc.
Carefully review the document and place a checkmark beside the conditions and drugs which apply to you... This will make it much quicker and easier for your provider, and will ensure that more than one code is listed (if appropriate). This will increase the probability that your insurance will approve the test.
- Checklist Included with Sample - a quick checklist of everything to be included in the FedEx package.
You don't need to give this to the provider (because you're trying to keep their paperwork to a minimum), but you can give it to whomever is subsequently finishing up with the collection samples and shipping them via FedEx.
Before Arriving at the Health Care Provider's Office
Before Arriving at the Health Care Provider's Office
Call your health care provider's office and ask that they copy your demographic sheet to include the front and back of your insurance card(s) and the list of your current medications. (If you forget, just have them do this when you check in so it will be ready when you check out.)
Make sure to pick up this demographic sheet (including your insurance information and current medications) when you are checking in, or if the clinic will be sending the completed test kit to the lab via FedEx, make sure it's included.
Introducing the DNA Test to your Provider
Introducing the DNA Test to your Provider
You can use the rationale statement at the top of this page.
Or you can use this "Talking Paper" discussed above:
My Request for Pharmacogenomics Test
Alternatively, to help you create your own personalized statement, below is the rationale I gave to my own doctor (Your health situation is different, so adjust these statements to your style and your particular health situation):
"Last year my wife suffered an adverse drug reaction that sent her to the hospital in an ambulance... Her face was so puffed up, you wouldn't recognize her, and she could barely walk. That got my attention! When I researched it, I learned that adverse reactions to legally prescribed medication is the #4 killer in America. So I looked into what I can do so we can avoid that in the future."
"I found out that the Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, St Jude's Children's hospital and several other prominent clinics have been pioneering the use of Pharmacogenomics (PGx) testing. Have you heard of it?"
My doctor replied, "Yes, I've heard a little bit about it."
"Well, the test will check all available drugs with my gene receptors to see if I need a higher dose or lower dose than the average person. And it will suggest an alternative drug if it's better for my particular genetic makeup and compatibility with my other drugs."
"I want this the test done so my current and future medications can be fine-tuned to my DNA profile.
I picked this particular lab* because in addition to a written report, it is the only lab which has a cloud-based test report.
That means ALL of my doctors can just log in with my login credentials, type in a drug they are considering prescribing for me, and see the results, as well as how it affects all of my other drugs so I don't get an adverse drug reaction...
... and unlike other lab reports, it's updated daily with future drugs for the rest of my life!
"Insurance companies and Medicare usually pay 100% for the test, but this particular lab is required by law to bill me for any remainder but does not require payment."
* [Point to the top of the Test Request Form which shows the lab logo... And the provider will see just below that logo that there are several items already completed by you, giving a subtle but strong, impactful hint that you fully expect a "Yes!"]
After Your Provider Agrees to Order the Test
After Your Provider Agrees to Order the Test
You could hand the entire packet to the provider... but I don't recommend this.
You don't want to make this process appear complicated to the point that your provider starts looking at their watch!
Rather than handing the entire packet to the provider, you'll want to make this easy, so hand one page at a time to your provider...
Want to print this section to review in the waiting room before seeing the doctor? Click here.
On the Test Request Form, point to the sections that the provider needs to complete... Just one page at a time!
Page 1:
- Testing Panel: Request that a Full Panel be ordered.
Rationale: "Because my gene/drug profile will be updated daily for the rest of my life, I'm bound to have some sort of health condition in the future which some future drug -- that hasn't been introduced yet -- might be prescribed for me... so I need the full panel."
We provide more detailed rational on this website specific to your provider: Order a Full Test Panel.
- Diagnostic Information:
- ICD-10 Diagnostic Codes: Give your provider the following document (at that point, not before then, because you are slowly feeding documents to the provider so he or she does not feel overwhelmed)...
PGx Medical Necessity/Med List - Hopefully you already checked the ones which you think apply to you. From those health conditions and drugs, the provider can list the appropriate ICD-10 codes.
- Additional Information: Preparing for surgery, etc. Again, refer to the PGx Medical Necessity/Med List.
- Special Conditions (Probably does not apply to you, but check to be sure.)
- Provider prints name and signs. (no date required)
Page 2: (no need to show provider)
- Nothing for the provider to sign (unless in New York). You already reviewed and signed this consent form (discussed above in Familiarize Yourself with Kit Contents).
Page 3:
- Hopefully you studied the different sections so you can make recommendations to your provider as to which items you think applies to you, just to speed things up for the provider.
- Clinical Report User Authorization Form
- If your Health Care Advocate gave you this additional form (for providers new to this service), have your provider complete the information (incluyou're the name and e-mail of the authorized users such as the nurse and/or office manager) and sign it.
Now the provider is finished, if they are delegating the rest to their staff! That was easy!
Let your provider know that the lab will send login credentials for the provider to have access to your test, and that we will send a 10 minute video which shows how to use the interactive test results.
If the Provider says "I'll fill this out later"...
If the Provider says "I'll fill this out later"...
Provide the paperwork with either of these pages on top (these were discussed above in Additional Forms Your Advocate May Have Given You):
Before leaving, settle on whether the clinic will collect the saliva samples and FedEx the package in the prepaid envelope to the lab, or whether you just need to depart while you've achieved your major objective (getting the provider to agree to order the test) and you'll have you Healthcare Advocate take care of those steps. Follow the steps below.
But before departing, be sure to collect that demographic sheet to be included in the FedEx package (discussed above).
Collecting the Saliva Samples
Collecting the Saliva Samples
At this point, the provider can have a nurse or other qualified person collect your saliva samples (or the provider can do it).
Note: Your Personal Healthcare Advocate is qualified to collect the sample and ship it to the lab, so you could be finished at this point in the provider's office if you wish to depart and have your Advocate collect the samples and ship it...
... But in that case, be sure you've picked up the demographic sheet with your current medications and insurance information at the front desk before leaving.
Then the collector needs to enter their name and date and clinic name on the bottom of the Test Request Form.
Note: This date must match the date that will be entered on the saliva samples pink envelope. That envelope has blanks to enter that same date, patient name, date of birth, and the collector's initials.
Tip: Suggest that the collector fill out the pink envelope while it's flat, before enclosing the swabs.
Hand the collector the Pharmacogenomics Test Ordering Instructions. Item #3 "Collect Sample" provides instructions.
Shipment
Shipment
Either the clinic or your Health Care Advocate will ship the package to the lab in the prepaid FedEx AirBill you were provided.
You don't need to know the details, but here is the shipping process.
As You Check Out
As You Check Out
Make an appointment to have your provider review the test results. It should be for 2-3 weeks after the sample is shipped.
Prior to Your Follow-Up Appointment
Prior to Your Follow-Up Appointment
You don't want to show up at your follow-up appointment to hear your provider say "I never got anything from the lab!"
So in the spirit of feeding your provider bite-sized chunks (who may have been reluctant to order this test for you in the first place), follow these two steps one-at-a-time.
Make sure the Provider has Received an E-mail from the Lab to Create the Portal for the Clinic
Make sure the Provider has Received an E-mail from the Lab to Create the Portal for the Clinic
Once your provider has signed the paperwork (above) and the clinic or your Advocate has sent the test kit (with signed paperwork) to the lab, the lab will review the paperwork with your insurance company to confirm they will pay for the test. If not, the lab will call you with a self-pay option, prior to performing the test.
Once the test is complete, the lab will send your provider an e-mail with information for the doctor to login to a portal to create the clinic's account on that test review portal. Call the clinic to:
(a) make sure the e-mail was received, and...
(b) the provider has created an account on the portal with the instructions in that email.
Then...
Have the Provider Prepare to Review the Test with You
Have the Provider Prepare to Review the Test with You
On the Thursday or Friday prior to your appointment on the following week, send the following website to the clinic and request that they forward it to your healthcare provider. (This will give the provider a chance to review the video over the weekend.)
That web page will prepare your provider to review the test (hence the name).
On that page are two videos:
- 90 Second Mayo Clinic Video: A Doctor’s “Aha!” Moment when she reviewed her OWN test results
This video succinctly explains doctor-to-doctor why this test is important for her patients as well as her own health.
- Demonstration of Cloud Based PGx Test
This video will open the provider's eyes to the power of this DYNAMIC cloud-based software for reviewing the test result. Therefore, your provider can more fully use this power during your review session to provide you the best personalized medicine for your DNA profile.
Summary of Forms
Summary of Forms
In addition to the instruction forms for whomever is completing the saliva test for you and sending the packet to the lab, the following is a review of the forms discussed above:
For the Provider to Sign
For the Provider to Sign
- Test Request Form / Genetic Testing and Billing Informed Consent
- Clinical Report User Authorization Form
From the Clinic
From the Clinic
- Demographic Sheet (your health summary)
- Copy of Insurance Cards (front and back)
- Insurance Cards
Optional
Optional
- Patient Request for Lab Results (notarized)
Not Needed in Fedex Shipment to the Lab
Not Needed in Fedex Shipment to the Lab
(Optional, but this is your paper to review while in the waiting room to refresh yourself on how to advocate to the doctor that you want this test. And if the provider says "I'll review these forms later, this is what would go on top of the forms.)
- PGx Test Request Letter or My Request for Pharmacogenomics Test (pick one, not both)
Questions?
Questions?
Hopefully this page has armed you with a great gameplan to successfully get your DNA test ordered.
If you have any questions, contact your Personal Healthcare Advocate.
Where to Go Next
Where to Go Next
Your Advocate will arrange to send to your provider the following page so the provider will be prepared to review the test with you in a follow-up visit: TestReview.DNA.fyi.
At the bottom of that page, we inform the provider: "Here are the benefits to the patient and to you and your clinic."
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