Prior auth appeal letter that actually worked

Three denied claims later, I finally got my Wegovy approved. Here's what changed in the third appeal: my doctor submitted a peer-to-peer review request AND cited the plan's own coverage policy language directly in the appeal. Insurance companies are betting you'll give up. Don't.

Same here — We're all in this together. That stall messed with my head too, you'll break through.

Totally agree. Incredible progress.

Honestly, That stall messed with my head too, you'll break through. Sending solidarity, this part is genuinely hard. You've got this.

Reading this and How long did the food noise take to quiet down. Did the nausea ease up after the first few weeks for you.

Adding my two cents: That stall messed with my head too, you'll break through. You're doing amazing. Hang in there.

Meal-prepping kept me from grazing on bad days.

Honestly, I split my routine around the shot day now and it helps. Down another 1.8 lbs this week and holding steady. Protein first at every meal has been my golden rule. Hang in there. (Not medical advice, just my own experience.)

Same here — Protein first at every meal has been my golden rule. Clothes are loose enough that I need a smaller size.

Coming back to this thread — Has your sleep changed at all since starting. I split my routine around the shot day now and it helps. You've got this. Everyone's different of course.

Such an inspiration honestly. So proud of you. Keep us posted!

Posting my insurance appeal letter since a few people asked. This is what finally worked after three denials: I had my doctor submit a Letter of Medical Necessity that specifically cited: (1) my BMI over 30 with comorbidities, (2) documented failure of two prior weight-loss interventions over 12 months, (3) relevant metabolic markers including elevated triglycerides and pre-diabetic A1C. The key addition that got it approved was asking the doctor to cite the specific plan coverage language and argue that denying the medication violated the plan's own obesity-management coverage terms. We also requested a peer-to-peer review call. Don't give up after one denial. Three denials is unfortunately normal. Each appeal should be more specific than the last.

Coming back to this thread, Talk to your prescriber before changing anything, but slow worked for me. Meal-prepping kept me from grazing on bad days.

Honestly, Down 3 lbs since my last shot, slow and steady. What's your current titration schedule looking like.

Adding my two cents: Rooting for you. I plan my meals around shot-day appetite changes now. Thanks for sharing this. Everyone's different of course.

For what it's worth, Electrolytes every morning has been a game changer. Talk to your prescriber before changing anything, but slow worked for me. Keep us posted! Definitely run it by your own prescriber though.

Cheering you on from here. Just hit my first 20 lbs and I can't believe it. Blood pressure is finally in normal range. Hang in there.

Totally agree. Strength training helped me keep muscle while losing. Strength training helped me keep muscle while losing. Ugh I felt exactly the same way at that stage. So glad I'm not alone in this.

Are you pairing it with any walking or strength work. Hang in there. (Not medical advice, just my own experience.)

Plateaus are the worst, hang in there. Thanks for sharing this.