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[ref] Mutations in the CFTR gene that cause cystic fibrosis can also cause pancreatitis

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Common reasons appeals succeed: The denial cited insufficient documentation, and the provider submits complete records showing all criteria were met The denial incorrectly stated the patient had not tried metformin, when pharmacy records show a 90-day trial The denial applied the wrong clinical criteria (e.g., requiring BMI 30 when the actual requirement is BMI 27 for diabetes patients) Common reasons appeals fail: The patient is requesting coverage for obesity without diabetes (no amount of documentation overcomes a formulary exclusion) The patient has not completed the required step therapy (metformin trial) The provider requested Wegovy instead of Ozempic for a diabetes patient (the appeal should request Ozempic instead) Step 3: Judicial review (within 30 days of Board of Hearings decision) If the Board of Hearings upholds the denial, you can file an appeal in Massachusetts Superior Court

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Edwards CMB, Stanley SA, Davis R, Brynes AE, Frost GS, Seal LJ, et al