Transcription of BRCA - Aetna
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BRCA - Aetna
Page 1 of 8 GR-67606-4 (3-23) Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy Precertification Information Request Form Applies to: Aetna plans Innovation Health plans Health benefits and health insurance plans offered and/or underwritten by the following: Allina Health and Aetna Health Insurance Company (Allina Health | Aetna ) Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner | Aetna ) Sutter Health and Aetna Administrative Services LLC (Sutter Health | Aetna ) Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna ) Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates ( Aetna ). Aetna provides certain management services on behalf of its affiliates.
counseling and validated quantitative risk assessment tool to have at least a 5% or greater pre -test probability of carrying a BRCA1 or BRCA2 mutation. Note: In this category only, a 3-generation pedigree and quantitative risk assessment results must be faxed directly to us at 1-860-975-9126. Pedigree template available on request.
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