Using ChatGPT for Dermatology Appeal Letters: A Modern Tool for Patient Access
Apr 1, 2025
Using ChatGPT for Dermatology Appeal Letters: A Modern Tool for Patient Access
By Janelle Ball
In the evolving world of dermatology, biologic coordinators and access teams are no strangers to the time-consuming and frustrating process of appealing insurance denials. Whether it’s step therapy mandates or rejections based on formulary preferences, crafting an effective appeal letter or Letter of Medical Necessity (LMN) can make the difference between delayed treatment and immediate patient care.
One tool I have started using is ChatGPT to help streamline the process. While some may be hesitant to incorporate AI into clinical documentation, it can be a powerful assistant—not a replacement for clinical judgment, but a partner in efficiency.
Why Use ChatGPT for Appeals?
AI tools like ChatGPT can help you:
Quickly generate professionally written drafts
Standardize appeal formats across providers
Reduce mental fatigue from trying to figure out what to say
Focus more on streamlining your workflow and patient care
Using ChatGPT for appeal letters doesn’t mean giving up control—it means giving yourself a head start.
What to Include in a Strong Appeal Letter
Whether you're appealing a step therapy requirement or advocating for a non-formulary biologic, a compelling letter should address both clinical reasoning and the patient’s quality of life.
🩺 Clinical Reasons to Avoid Step Therapy (e.g., Methotrexate)
If the insurance company requires a trial of methotrexate or another systemic before approving a biologic, provide clear documentation of:
Contraindications: Liver disease, pregnancy, renal impairment, or alcohol use disorder
History of adverse effects or intolerance
Need for rapid response due to the severity of disease (e.g., erythrodermic psoriasis, high BSA involvement, risk of infection)
Monitoring burden: Lab testing and clinic visits can be excessive for some patients, particularly those with transportation or financial barriers
Patient preference after being fully informed of risks/benefits, especially if methotrexate has been offered and declined due to tolerability concerns
❤️ How Skin Disease Impacts Quality of Life
Dermatologic conditions are not just skin-deep. Be sure to include statements that highlight:
Social withdrawal due to visible plaques or lesions
Impaired ability to work, especially in careers involving public interaction or manual labor
Sleep disruption from itching, pain, or bleeding
Mental health burden, including depression or anxiety
Impact on family or caregiving roles, especially for patients managing households or children
When possible, quote the patient directly or include validated tools (e.g., DLQI scores) to demonstrate disease burden.
Overcoming Hesitation Around AI Use in Appeals
Some providers may feel unsure about using AI-generated content in clinical appeals. Common concerns include:
Lack of personalization
Fear of errors or outdated information
Perceived lack of professionalism
Here’s the truth: AI should be used as a drafting tool, not a final product. Think of ChatGPT like a medical scribe—it gives you a framework, but your knowledge and documentation turn it into a polished letter.
By reviewing and customizing the content, you ensure it aligns with your clinical judgment and your patient’s unique story.
How to Ask ChatGPT for Help with an Appeal Letter
When using ChatGPT to draft an appeal letter, the more specific you are, the better the result. Be sure to include key details like the diagnosis, medication denied, reason for the denial, relevant medical history, and any clinical justifications (e.g., contraindications to step therapy, failed past treatments, or disease severity). You should also share how the condition is impacting the patient’s daily life or work, especially if it ties into the urgency of the request. Avoid including protected health information (PHI) like full names, birthdates, or insurance IDs—ChatGPT doesn’t need that to help you craft a solid letter. Think of it as writing a case summary for a colleague: clear, professional, and focused on the “why this matters.”
🧑⚕️ Example Prompt to ChatGPT:
Hi ChatGPT, I need help writing an appeal letter. A patient with severe plaque psoriasis (covers 40% BSA) was denied coverage for Taltz because insurance wants them to try methotrexate first. The patient has a history of liver disease, making methotrexate unsafe. They also have depression, and the condition is affecting their self-esteem and work life—they’re a school teacher and feel embarrassed due to visible plaques on their face and arms. Can you help me write a letter to request a medical exception for Taltz, including both clinical and quality-of-life reasons?
✅ You’ll notice this request includes:
Diagnosis and severity
The medication requested and what was denied
Reason step therapy isn’t appropriate
Impact on daily life or work
A clear ask: a medical exception letter
📄 Appeal Letter Template - Example
Appeal Letter for Biologic Therapy in Severe Atopic Dermatitis
[Provider Letterhead or Practice Information]
Date: [Insert Date]
To: [Insurance Company Name]
Medical Director or Utilization Review Department
[Insurance Company Address]
[Fax Number or Portal]
Re: Appeal for Coverage of [Biologic Medication Name] for Atopic Dermatitis
Patient Name: [Patient Full Name]
Date of Birth: [MM/DD/YYYY]
Insurance ID #: [Insert Member ID]
Group #: [Insert Group ID]
Medication Requested: [Biologic Medication Name & Dosage]
Diagnosis: Severe Atopic Dermatitis (L20.9)
Dear Medical Review Team,
I am writing to formally appeal the denial of coverage for [Biologic Medication Name] for my patient, [Patient Name], who has been diagnosed with severe atopic dermatitis involving over 70% of total body surface area (BSA), including his hands, feet, scalp, and stomach.
The denial cited the patient’s lack of a documented trial and failure of a topical corticosteroid or calcineurin inhibitor. However, in this case, the severity, extent, and location of disease render topical therapy both impractical and clinically inappropriate. I am requesting a medical exception to your step therapy protocol based on the following clinical and quality of life considerations:
Clinical Rationale for Bypassing Topical Therapy
- Extensive BSA Involvement: The patient presents with over 70% BSA affected, making widespread application of topical agents not only unrealistic but also ineffective and burdensome.
- High-Impact Areas: Involvement of the hands and feet significantly impairs the patient’s ability to function, particularly given his occupation in a mailroom environment that requires constant handling of packages and mobility.
- Chronicity and Severity: The patient has experienced longstanding, uncontrolled flares with lichenification, excoriation, and pruritus, significantly impacting daily life.
- Risk of Non-Adherence: Due to the volume of medication required, discomfort during application, and occupational interference, adherence to a topical regimen is not feasible and would likely lead to continued treatment failure and worsening of disease.
Quality of Life and Functional Impairment
[Patient Name] works full-time in a physically demanding role as a mailroom assistant, requiring use of his hands for sorting, lifting, and packaging throughout the day. His condition causes:
- Painful fissures and bleeding on his hands and feet, interfering with work duties.
- Constant itching and visible inflammation, leading to social withdrawal and emotional distress.
- Difficulty sleeping due to severe pruritus, contributing to fatigue and reduced productivity.
- Scalp involvement that causes flaking and discomfort, further affecting self-esteem and social interaction.
Request and Supporting Guidelines
[Biologic Medication Name] is FDA-approved for the treatment of moderate-to-severe atopic dermatitis in patients who are candidates for systemic therapy. According to AAD guidelines, systemic agents may be considered when topical treatments are impractical due to extensive involvement or occupational limitations—as is the case here.
Given the clinical severity, inadequacy of topical therapy, and significant occupational and functional impairment, I strongly urge you to reconsider your decision and approve coverage for [Biologic Medication Name] for [Patient Name].
If further documentation is needed, please do not hesitate to contact me at [Provider Phone Number].
Thank you for your time and consideration in this urgent matter.
Sincerely,
[Provider Name, Credentials]
[Practice Name]
[NPI #]
[Signature]
What else to include with this appeal:
- Clinical visit notes
- Photographs (if applicable)
- Prior treatment history
- Documentation of disease impact
- Peer-reviewed literature supporting systemic therapy in extensive AD
✅ Must-Do’s Before Sending the Appeal Letter
To increase your success rate:
Gather comprehensive documentation
Chart notes, previous treatments, photos, lab results, etc.
Use patient-specific details
Mention comorbidities, failed therapies, personal/social impact
Check insurance-specific appeal forms or portals
Some payers require their own formats or have e-fax systems
Include supporting documentation
Peer-reviewed articles, guidelines, or prescribing information when relevant
Proofread for tone and accuracy
Ensure the letter is professional, personalized, and factually sound
Include provider signature
It adds credibility and reflects accountability
Final Thoughts
AI is not here to replace the human touch—it’s here to support it. With ChatGPT, you can build more effective appeal letters, faster, without sacrificing quality. In the high-stakes world of dermatologic care, where every delay matters, these tools can be game-changers.
By combining clinical expertise with thoughtful technology, biologic coordinators and providers can advocate more effectively, secure timely access, and most importantly—put patients first.
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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.