PriorAuthAppeal

Denied for Ozempic, Wegovy, Mounjaro, or Zepbound?

We match your denial against your insurer's exact published GLP-1 policy — UnitedHealthcare, Aetna, Cigna, and 7 others — and email you a physician-ready appeal letter in under 30 minutes.

$59
Flat fee · No subscription
Money back if your doctor won't sign it

Start your appeal now

Quick medical context (90 seconds)

What you'll receive

Within 30 minutes of payment, three files arrive in your inbox: a 2–3 page appeal letter your physician signs, a one-page summary for the physician's office, and a checklist of supporting documents to attach.

Every letter cites your insurer's actual published GLP-1 coverage criteria (we maintain policies for the 10 largest US insurers) plus the relevant clinical guidelines (AACE 2023, ADA 2025). Your denial text and intake info are deleted within 1 hour after delivery.

30 mindelivery
$0data retained
100%refund if not signed

$59 vs ~$16,000 a year.

GLP-1 weight-loss drugs run $900–$1,350 per month without coverage (Wegovy is ~$16,200 a year out-of-pocket). With insurance coverage after a successful appeal, the typical copay drops to ~$25–$50 a month. The service fee pays back in roughly two days of covered medication.

Successful appeals are routine when documented properly with the right policy citations — but your insurer decides, not us. If your physician declines to sign the letter, you get a full refund. You risk $0.

How it works

  1. 1

    Paste your denial letter

    Just text — we don't ask you to upload your full medical record. We delete what you paste within 1 hour after delivering your letter.

  2. 2

    Pay $59 via Stripe

    One-time charge. No subscription. Charged immediately so we can start working — but with a money-back guarantee if your physician declines to sign the letter as drafted.

  3. 3

    Receive your letter in 30 minutes

    You'll get a 2–3 page appeal letter, a 1-page summary for your physician's office, and a checklist of supporting documents to attach. Your physician reviews, signs, and submits.

Sample appeal letter

Real letter generated for a synthetic patient — UnitedHealthcare denying Wegovy for incomplete lifestyle-modification documentation. The patient's name and member ID are fictional; the policy citations, statute references, and clinical guideline quotes are the exact language the system produces for a real case.

Jane Doe
Member ID: UHC-XXXXXXXX
Date: May 03, 2026

UnitedHealthcare
Appeals Department

Appeal of Prior Authorization Denial — Wegovy (semaglutide)

Dear UnitedHealthcare Appeals Department,

This letter constitutes a formal written appeal of UnitedHealthcare's denial of prior authorization for Wegovy (semaglutide injection 2.4 mg) for the above-named patient, as communicated by denial notice dated April 28, 2026, under denial code CO-50. The denial is respectfully contested on the grounds that it is factually inconsistent with the patient's documented medical history and directly contradicts UnitedHealthcare's own published criteria under the Medical Benefit Drug Policy: Weight Loss Pharmacotherapy.

The patient unambiguously satisfies UnitedHealthcare's published eligibility criteria. The patient presents with a body mass index of 32.4 kg/m², accompanied by two clinically significant, UHC-recognized weight-related comorbidities: hypertension and obstructive sleep apnea. Accordingly, the only remaining criterion at issue is documentation of a comprehensive lifestyle modification program — a criterion the patient fully and demonstrably meets.

The patient completed nine months of Weight Watchers in 2023 — a program explicitly recognized by UnitedHealthcare's policy as a qualifying structured intervention — followed by four months of Noom in early 2024, also recognized by UHC policy. Together these represent thirteen months of structured, multi-modal lifestyle intervention in insurer-recognized programs, supplemented by an ongoing eight-month PCP-supervised low-carbohydrate dietary protocol with structured physical activity.

The prescription is firmly supported by current authoritative guidelines: the AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity (Garvey et al., Endocr Pract. 2023) and the ADA Standards of Care 2025, Section 8 both recommend pharmacotherapy as an adjunct to lifestyle therapy for patients meeting this BMI-plus-comorbidity profile who have not achieved durable response from lifestyle alone.

We respectfully request that the April 28, 2026 denial be overturned. The patient is entitled to a full and fair review pursuant to ACA §2719, ACA §1557, and ERISA §503 (29 CFR § 2560.503-1). Should the internal appeal not result in approval, the patient expressly reserves all rights to external independent review.

Sincerely,
______________________
Jane Doe

Reviewed and signed by:
______________________
Dr. Sarah Chen, Internal Medicine
Date: May 03, 2026

What goes into every letter

A generic AI prompt can write something that looks like an appeal letter. It cannot do these things — which is what makes the difference between a letter your physician signs and one they delete.

  • Your specific insurer's published criteria, by name. We maintain a curated database of the 10 largest US insurers' GLP-1 medical policies (UnitedHealthcare, Aetna, Cigna, Anthem, BCBS regional, Kaiser, Humana, and others), refreshed when insurers update them. Each letter cites your insurer's exact policy section, not generic insurance language.
  • The clinical guidelines insurer medical reviewers actually respect. AACE 2023 (Garvey et al., Endocrine Practice) and ADA 2025 Standards of Care, Section 8 — quoted with the right page references and matched to your specific clinical profile. Not made-up citations.
  • The right federal statute for your plan type. ACA §2719 for marketplace plans, ACA §1557 nondiscrimination, ERISA §503 (29 CFR § 2560.503-1) for employer-sponsored plans. The wrong statute citation is an easy way for a reviewer to dismiss an appeal.
  • Your exact denial code, addressed criterion-by-criterion. CO-50, N-431, N-130 — each requires a different rebuttal. We read your denial letter, identify the codes used, and structure the appeal to address each one with documentation from your own intake.

If you want to draft this yourself, our insurer-specific guides walk through every step. Some patients do, and the guides are written to be useful either way. The $59 service exists for patients who'd rather not spend the 6–10 hours.

Detailed appeal guides by insurer

Each guide walks through that insurer's specific GLP-1 coverage criteria, the most common denial reasons they cite, and how to address each one. Useful even if you decide to draft your appeal yourself.

Don't see your insurer? Start your appeal anyway — our agent has policy data for the 30 largest US insurers, and we add new pillar guides regularly.

Detailed appeal guides by medication

Each guide explains the FDA-approved indication for that specific GLP-1, the clinical trial evidence behind it, the most common reasons insurers deny it, and how to build the strongest appeal. Useful for patients who know exactly which medication they were denied.

Prescribed a GLP-1 not listed here (Saxenda, Trulicity, Bydureon)? Start your appeal anyway — our agent supports all FDA-approved GLP-1 medications.

FAQ

Does this guarantee my appeal will be approved?

No. We guarantee a physician-ready letter — well-formatted, citing your insurer's own policy and the relevant clinical guidelines. Approval rates depend on your specific clinical profile and your insurer. What we promise: the letter is high-quality enough that your physician will sign it, or you get a full refund.

Does my doctor have to do anything?

Yes — they review and sign the letter, then their office submits it to the insurer (typically by fax or via the provider portal). Most physicians are happy to sign a well-drafted letter their patient brings them — it saves them 20–40 minutes of work.

What if my doctor won't sign it?

Full refund within 7 days. Reply to your delivery email with the word DECLINED and we'll process the refund — typically within 1–2 business days. We reserve the right to deny refund requests where we detect evidence of bad-faith use of the service.

Is this legal?

Yes. We draft a document that you and your physician decide whether to use — the same legal posture as LegalZoom or Rocket Lawyer. We are not practicing medicine or law on your behalf. We do not communicate with your insurer. Your physician is the medical decision-maker.

Why can't I just ask ChatGPT to write this for free?

You can. The difference: we maintain a curated database of your specific insurer's published GLP-1 criteria (UnitedHealthcare's policy is different from Aetna's; Cigna's is different again). ChatGPT doesn't have that — it will write a generic letter that may cite non-existent criteria. Our letter cites your insurer's exact policy section by name.

If you'd rather DIY with ChatGPT, that's a legitimate choice. We exist for the patient who wants a finished, signable letter in 30 minutes without becoming a prompt engineer.

Is my medical information secure?

We don't retain it. The denial text and intake form are processed transiently and deleted within 1 hour after we email you the letter. We retain only the minimum metadata needed for billing and refunds (your email address and Stripe customer ID). We never sell or share data.

How fast is "30 minutes" really?

Most letters arrive within 30 minutes of payment. During off-hours or periods of elevated provider load, delivery can take longer. If you haven't received your letter within a few hours, email hello@priorauthappeal.com and we'll investigate immediately.

Two paths from a denial letter

Without us

  • 2–8 hours of research
  • Generic appeal templates from forums
  • Risk of citing wrong policy section
  • Many give up before filing

With us

  • 30 minutes, $59 flat
  • Citation-grounded letter
  • Insurer-specific policy match
  • Refund if your doctor won't sign
Start my appeal — $59