GLP-1 Collective

Appeal letter builder

A first draft, written
in your browser.

Fill in what you know and this writes an appeal letter you can print, correct and take to your prescriber. It runs entirely on your device. Nothing you type is sent anywhere or stored on any server, and closing the tab is enough to be rid of it.

What this is, and what it is not

This is a starting draft written from a standard template, not legal or medical advice, and not a letter of medical necessity. The clinical argument has to come from the person who prescribed the medication and knows your history, so the most useful thing you can do with this draft is bring it to that office and ask them to correct and sign their part. Check every detail before you send it, because we cannot check any of them for you.

Conditions your prescriber is treating (tick any that apply)

Before you send it

Ask your plan for the written criteria it applied, because a letter that answers those criteria one by one is far harder to refuse than a general one. Keep a copy of everything you send and note the date you sent it. You have 180 days from the denial notice to file an internal appeal, and the insurance page sets out the rest of the deadlines.