I recently purchased a return flight for my wife using my CSR (CLT to MKE) for late July. We used points to book through the portal with AA (ticket was ~$423). I don't have any status with AA. She's unable to make this flight now after throwing out her back and having a appointment with the surgeon booked for the flight date.

What are my options for any sort of refund or regaining value?

Pay the $200 AA cancellation fee and get back the remaining $223?
Plead my case to AA?
Where would a refund go? Back on as points to the CSR?
Does the CSR offer any travel protection here?