Was denied gap exemption for neuro rehab and need advice

I’m not sure if this is the right place to put this and if it’s not, I apologize and would appreciate any advice or where the best place would be to ask about this.

I am in Texas. Sorry in advance for the essay.

I recently suffered a traumatic brain injury and have been undergoing neurological rehabilitation. Unfortunately, the rehabilitation is very expensive, and my insurance doesn’t cover it. My doctor suggested applying for a gap exemption, as she’s the only neurological rehabilitation doctor in my area, and most of her patients are usually able to get them.

However, my insurance denied it, stating there’s another facility nearby that accepts my insurance. However, the alternative facility specializes in pediatric therapy for developmental problems in children. I’m in my twenties and need rehab for an injury, not developmental issues from childhood. I even know first-hand that they do not accept adults because I called them when I was looking for a neurological rehabilitation doctor and they turned me away. Even though I’m an adult, (and they know that), my insurance reached out to the pediatric rehab doctor, who surprisingly agreed to see me and become my new rehab doctor. However, I don’t believe she would be the best fit for me.

Nowhere on her website suggests she sees adults. All of the pictures on her website feature children. The list of things she specializes in are none of the problems I am having and would not help me in the slightest so I’m not sure what made her think she would be the best choice for me.

Also, (I am not sure if this is relevant or even true) I’ve heard that doctors who see adult patients are required to accept Medicare, and if they only see children, they are not required to accept it. However, the pediatric rehab doctor’s website doesn’t list Medicare as one of their accepted insurances, which further tells me she does not deal with adults at all and would not be able to properly help me. I do not have Medicare however, so I am not completely sure about that.

To me, this feels very scummy. It feels like instead of prioritizing my wellbeing, she is only doing this to get paid. I am sure she is great at what she does, but she does not specialize in adults with head trauma and as far as I know, never has. It’s frustrating to feel like I’m being pushed towards a solution that would not be the right fit for my recovery, just because my insurance doesn’t want to pay for it.

I absolutely love my current doctor and do not want to switch as I am comfortable with her with her and feel like she actually cares about my wellbeing and recovery. I also don’t want to re-explain everything therefore slowing my recovery. It also helps that my current doctor actually specializes in with head trauma and not children with learning disabilities, who would have thought? I am not going to see the pediatric doctor either way as this whole situation has left me angry and disparaged. I may not be able to see my current doctor anymore and not get the help I need all thanks to a greedy and unqualified idiot. I know I am making a lot of assumptions about this doctor, but I am past the point of caring.

I’m at a loss for what to do next. I don’t know if I should try to speak with the pediatric rehab doctor and explain that her expertise isn’t going to help me in the slightest. On the slight chance she agrees to retract her statement I doubt my insurance would care. I don’t know if I should contact my insurance and again, and explain the situation, although I doubt they’d be any help at all. It just sucks because this pediatric doctor ruined my chance to get a gap exemption when I am sure she knows full well that she is not the right person for the job.

Any advice or similar experiences would be greatly appreciated. Thank you in advance.

submitted by /u/braininjuryhelp
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