Ann, your appeal on grounds of medical necessity could also be assisted by a referral from the doctor who made the initial diagnosis and a recommendation by Dr Ahalskog. Do you have these? And, if not, would you be able to secure these from the doctors? I don't have the details of your health plan but, generally, insurers go by "medical necessity". Enlisting the assistance of both doctors could further support your appeal and would take it outside of the insurer's subjective test.

And to tie up the legal obligation of the insurers to Dotsie's, it could perhaps go in the way of:

"I understand that my health plan provide coverage for crucial treatments under the circumstances and now eagerly await your urgent response..."