This checklist will guide you in completing your self-service appeal letter and preparing it for appeal submission.
1. Before editing
Before editing make sure to…
- Have a copy of the denial letter for the medication you want your insurance to approve nearby.
- Contact your insurance to confirm your appeal process. It can vary depending on the insurer.
- Read the appeal letter we attached to your email thoroughly before starting to edit or submitting your appeal.
2. Edit your appeal letter
We added [**bracketed**] notes in your appeal letter for possible edits. Replace these notes with the information or delete them before sending. Below are common edits we make.
- Denial reason
Confirm that the denial reason in the first paragraph of the appeal letter matches the denial reason your insurance has stated in your denial letter.
- Medical necessity
The second paragraph in your appeal lists out the medical reasons you were prescribed a GLP-1. Include any additional supporting clinical information in your history section, such as improvements in HbA1c, blood pressure, triglycerides, etc.
- Previous GLP-1 history
If you’ve taken a GLP-1 medication before, read over your previous history with GLP-1 medications and ensure the provided information fits your experience with the medication.- In some cases, including information about ineffective medications can strengthen your appeal by showing you can’t use insurance preferred medications. Add dates, durations, and any negative effects. We don’t recommend including medications with the same active ingredient as the one you’re appealing.
- Weight loss programs
Weight loss program history can be important for some cases. Include any relevant information regarding weight management programs in which you’ve participated in the appropriate paragraph.- If required, gather any additional information regarding previous lifestyle modification attempts, such as receipts and documentation of participation in weight management programs (Weight Watchers, Noom, Found, etc)
3. Get ready to send
- Double check information
Before completing your letter, double check all personal and medical information to make sure it is correct. For example listed weights, BMIs, diagnoses, dates, durations of treatments, etc
- Add header and footer information
Replace any [bracketed] content with the requested information.
- How to submit
Decide if you’ll be submitting your appeal yourself, or having your healthcare provider submit for you.- If submitting yourself, confirm how your insurance provider requires you to submit your appeal. Fax, mail, phone, etc.
- Note the contact information for the appeals department of your insurance plan
Need help?
