Diagnosis: Ovarian Cancer.
Treatment: FoundationOne CDx Test.

The insurer denied the FoundationOne CDx Test.
The denial is upheld.

The patient in this case is a woman with ovarian cancer. Foundation One testing was performed.

No. The proposed treatment is not medically necessary.

Foundation One testing is a next generation sequencing assay that is done to look for genomic alterations in tumor tissue. This test includes over 300 genes. It is done to try to find potentially effective treatment options. There is currently no evidence based on the results of any prospective clinical trial that has shown use of broad molecular profiling can improve overall health outcomes. This specific test is not recommended as a standard test known to improve overall health outcomes by the National Comprehensive Cancer Network (NCCN) guidelines. Given these considerations, this test is not medically necessary.

Yes. The health plan did act reasonably, with sound medical judgement and in the best interest of the patient.