Appeal letter template — anyone have experience?

Adding my success story: Anthem BCBS, denied twice, approved on appeal.

What made the difference for me was getting my cardiologist to write a supporting letter, not just my PCP. I have a history of MI, and my cardiologist wrote that GLP-1 therapy was medically necessary for secondary cardiac prevention, citing the SELECT trial showing 20% MACE reduction.

Anthem couldn't really argue with a cardiologist saying "this patient needs this drug to not have another heart attack." Approved in 5 days.

Lesson: if you have relevant specialists, get them involved in the appeal. A letter from a specialist carries more weight than one from a PCP alone.

roxy_nash, that's a fantastic point about specialist letters. My endocrinologist's letter was definitely what pushed mine over the edge too.

Summary of what works on appeals based on this thread:

• Address the insurer's specific denial criteria point by point
• Document supervised lifestyle modifications (dietitian, structured programs)
• Document prior medication trials with specific outcomes
• List all comorbidities with ICD-10 codes
• Cite clinical trial data (SELECT, STEP, SURMOUNT)
• Include specialist letter(s) of medical necessity
• Frame as chronic disease management, not elective weight loss
• Make the cost-effectiveness argument

Dr. Martinez — you're amazing for offering to review letters. This community is the best.

Pinning this thread. This is one of the most useful resources we've created as a community.

For anyone starting the appeal process, please also check our wiki page on insurance navigation — it has state-by-state resources for filing complaints with your Department of Insurance if internal appeals are exhausted.

Remember: you have the RIGHT to appeal, and insurers count on most people giving up. Don't give up.