Well I work to send appeals and insurance companies will only do peer to peer appeals. Meaning a physician to medical staff. You'd be surprised to see who's making decisions at th insuracne companies. My docs have spoken to ob nurses to appeal decisions regarding epilepsy. Like umm excuse me who are you to deny anything not related to your field. So you're more than welcome to send your letter or even speak to your determiner however the physician and his office should handle any formal appeals because you're usually given one chance and if that chance is again denied you have 30 days to file a written appeal. Don't take any chances I'm sure they're familiar with the dialogue and good luck i;m sure things will work out.