Insurance Appeal Center
Use the universal appeal letter template below and adapt it to your insurer. We also include brief tips for Aetna, BCBS, and UnitedHealthcare. Always follow the appeal instructions and deadline on your denial letter.
Tips by insurer
Use the universal template below; adapt medical necessity and address to your plan.
Aetna
- Prior authorization (PA) is often required; include ICD-10 and duration of therapy.
- Weight-loss–only (e.g. Wegovy) may require step therapy; document previous attempts if any.
- Use the universal template below and adapt the medical necessity paragraph to your case.
Blue Cross Blue Shield (BCBS)
- Coverage varies by state and plan; check your BCBS formulary for GLP-1 tier and PA requirements.
- Include physician letter and relevant labs (A1C, BMI, comorbidities).
- Universal template works as a starting point; add plan-specific appeal address from your denial letter.
UnitedHealthcare
- PA criteria often include BMI threshold and/or type 2 diabetes; document both if applicable.
- Expedited appeals may be available for urgent cases; check your denial letter for instructions.
- Use the universal template and attach supporting records; address to the appeal department on your denial notice.
Universal appeal letter template
Copy and adapt; your doctor should sign and attach supporting records.
[Your name]
[Member ID]
[Date]
[Plan name]
[Appeal address / portal]
Re: Appeal for [Drug name] – [Member ID]
I am writing to appeal the denial of coverage for [drug name] for the above member.
Medical necessity:
[Patient] has been diagnosed with [e.g. type 2 diabetes / obesity with BMI ___ and related conditions]. [Drug name] is medically necessary because [brief reason, e.g. inadequate control on other medications, need for weight loss to reduce cardiovascular risk].
Supporting documentation from the prescribing physician is attached, including diagnosis, treatment history, and clinical justification.
I request that the plan approve coverage for [drug name] in accordance with the member's prescription and formulary procedures.
Sincerely,
[Your name / Physician name and contact]
This is a starting point only. Your doctor should customize the medical necessity section and attach relevant records. Check your plan's appeal instructions for any required forms or formats.
