Not legal, medical or financial advice. LetterRuler drafts wording from the facts you type. It does not know the rules that apply to your situation and cannot promise any outcome. For eviction, immigration, employment, insurance, tax or court matters, have the draft reviewed by a qualified professional or a free legal aid service before you send it.
- Honest draftsBuilt only from the facts you type
- Nothing storedDrafts are not saved or used for training
- Edit before sendingYou review every line
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What to include
- Member ID and drug name as prescribed
- Denial reason (for example "excluded" vs "criteria not met")
- Relevant measurements and conditions documented by your clinician
- Prior programs tried
- Prescriber letter
Tip: Check whether the denial says the drug is excluded from your plan or that criteria were not met. An exclusion is very hard to appeal; missing criteria may be fixable with records.
Example of facts to type
The tool works best with plain facts like these (made-up example):
My plan denied coverage for a GLP-1 medication my doctor prescribed in September 2026. My BMI is 36, I have high blood pressure, and I followed a supervised diet and exercise program for 6 months in 2025.
Letter outline you can copy
Prefer to write it yourself? Use this structure. Replace everything in [brackets].
[Your name and contact details] [Date] [Appeals department / committee and address] Re: Appeal of [decision] - [reference / claim / ID number] Dear [Name or committee], Paragraph 1: You are appealing the decision dated [date] and what it decided. Paragraph 2: The reason given, quoted exactly. Paragraph 3: Why you believe it should be changed: facts, dates, and new or overlooked evidence. Paragraph 4: The outcome you request and the documents enclosed (numbered). Please send your decision in writing to [address/email]. Sincerely, [Name]
How to write an appeal letter
An appeal asks someone to look again at a decision. The best appeals answer the stated reason for the decision directly, add any evidence that was missing, and ask for a clear outcome.
- Check the deadline in the decision letter and file before it.
- Quote the reason for the decision and respond to it point by point.
- Enclose evidence and list it at the end of the letter.
- Stay calm and factual. Accusations without evidence rarely help.
Before you send it
- Replace every [bracketed] placeholder or delete the line.
- Check that each date, amount and name is exactly right.
- Remove anything that is not true or that you cannot support.
- Keep a copy and note when and how you sent it.
Related appeal letters
- Appeal letter to insurance company for denial of claim
- Appeal letter for dental insurance denial
- Appeal letter for medical necessity
- Appeal letter for medication denial
- Appeal letter for unemployment benefits
- EDD appeal letter (California unemployment)
- Appeal letter for financial aid
- Appeal letter to college for more financial aid
Frequently asked questions
Does this work for Wegovy or Zepbound?
The same structure applies to any brand. Use the exact drug name on your prescription.
Will the appeal succeed?
Nobody can promise that. Coverage depends on your plan's terms.
Is LetterRuler free?
Yes. There is a daily limit on free letters so the service stays free for everyone.
Do you keep my letter?
No. Your text is sent to Cloudflare Workers AI to create the draft and is not stored in our database. See the privacy policy.