An appeal beats a denial. An appeal cannot beat a plan exclusion — and most template sellers will happily sell you one anyway. Answer two questions from your actual denial letter.
Most appealed prior-authorization denials are overturned when the appeal carries the right evidence: BMI history with dates, comorbidities, the step-therapy trail, the FDA indication, and a physician statement. Deadlines: internal appeal typically 180 days; then independent external review.
One more check worth 30 seconds: if the denial arrived near-instantly or names no reviewing physician, several states now bar algorithm-only denials — asking in writing "identify the licensed physician who reviewed this claim" can make the denial procedurally defective regardless of merits.
If the plan excludes anti-obesity medication as a category, no appeal letter fixes it. Your real routes: the employer plan-change letter (benefits committees add GLP-1 riders at renewal), manufacturer savings programs, and one edge case — if your Summary of Benefits lists no such exclusion, that conflict itself is appealable as a plan-document error.
Search it for "weight loss" under exclusions. Listed there = exclusion route. Not listed, and your letter talks about criteria or authorization = denial route, appealable. Your plan must give you the SBC on request.