Insurance appeal letter generator

How to use this letter

1. Fill in the fields above with your information and the exact denial reason cited in your insurance letter.
2. Click Generate appeal letter.
3. Review the draft — it's a starting point, not the final letter.
4. Have your prescriber review and add their clinical reasoning. Most successful appeals have a separate letter from the prescriber attached.
5. Attach the original denial letter, prescriber's letter of medical necessity, and any relevant medical records (BMI history, comorbidity documentation).
6. Submit per your insurance plan's appeal instructions. Most plans accept email/portal upload; some require fax or certified mail.
7. Track timing. Non-urgent appeals typically must be decided within 30 calendar days (varies by state and plan type).
8. If denied at first level, escalate to second-level appeal, then to external review if available.

What makes appeals succeed

• Specific clinical documentation. A letter that says “BMI 33.2, type 2 diabetes A1C 7.8, hypertension on lisinopril, prior 6 months of structured lifestyle program with 4 lb loss” beats a letter that says “patient is obese and needs treatment.”
• Prescriber engagement. Plans take appeals more seriously when the prescriber is engaged. A peer-to-peer review with the plan's medical reviewer (which your prescriber can request) often reverses denials.
• Citing FDA-approved indications and current guidelines. AACE/Obesity Medicine Association 2024-2025 guidelines explicitly support GLP-1s as first-line for patients meeting criteria.
• Documenting prior failures honestly. Plans look for step-therapy completion. List specific programs, durations, and outcomes.
• Persistence. Many successful appeals took 2-3 rounds. Don't accept the first denial as final.

Related

• Insurance coverage hub by carrier →
• LillyDirect & NovoCare direct-pay →
• Wegovy savings options →
• Insurance pre-check tool →