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What If My Appeal Is Still Denied? (The "Flight" Path)
Sometimes, despite a perfect appeal, the answer is still no. Employers with self-funded plans have the final say, and some simply refuse to cover these medications. If you have exhausted your internal appeals and an external review, you have two remaining options:
1. The Peer-to-Peer Review
Ask your doctor to schedule a "Peer-to-Peer" call with the insurance company's medical director. Sometimes, a doctor-to-doctor conversation can overturn a denial that a letter could not [cite: 1, 2].
2. The Affordable Cash-Pay Alternative
If insurance is a dead end, you are not out of options. The "Flight" path involves moving to a trusted telehealth provider offering compounded GLP-1 medications. These are not the $1,000 brand-name pens, but rather vials of the active ingredient (semaglutide or tirzepatide) compounded in FDA-regulated 503A/503B pharmacies.
We maintain a forensic database of these providers, vetting them for legitimacy, shipping times, and pricing. Many patients find they can access the same treatment for $200–$400 per month—a fraction of the retail cost.
View our Comparison of Top-Rated Compounded Providers.
Frequently Asked Questions
Does the Appeal Generator work for Zepbound and Wegovy?
Yes. The tool is updated with the specific FDA indications for both Semaglutide (Wegovy/Ozempic) and Tirzepatide (Zepbound/Mounjaro), including recent updates regarding cardiovascular health and sleep apnea.
How long does the appeal process take?
Insurance companies are legally required to respond to an internal appeal, usually within 30 days for standard requests and 72 hours for urgent requests. However, gathering your documents and writing the letter can take time—unless you use our generator.
Can I appeal if my plan has a strict exclusion?
You can try, but it is difficult. In exclusion cases, your best bet is often to argue for coverage based on a secondary indication (like heart disease prevention) rather than weight loss, or to explore our recommended cash-pay alternatives.