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The Level 2 appeal should include: Everything from Level 1 A detailed letter from your provider explaining the medical necessity Published clinical guidelines supporting use (ADA Standards of Care, Endocrine Society guidelines) Any additional clinical information (labs, imaging, specialist notes) Success rates: Level 1 appeals: ~28% approval rate Level 2 appeals: ~41% approval rate Combined (patients who appeal through both levels): ~56% eventually approved The data shows persistence matters