Three and a half years ago, Caleb Wilson’s life changed forever.
A freak accident at a boat ramp left him with a severed spinal column, dislocated foot, and skull fracture.
Thanks to his medical team’s expertise, his father Rodney Wilson’s advocacy efforts and the work of dedicated professionals at BlueCross BlueShield of Tennessee and its subsidiary, BlueCare Tennessee, 21-year-old Caleb spent the anniversary of that accident in England as part of a college study-abroad program.
“London was incredible – definitely one of the best experiences of my life,” said Caleb.
“I’ve had a lot of opportunities that I didn’t think I would have. I’ve been very fortunate.”
The road to recovery
Caleb, a gifted athlete, had youth and strength – both mental and physical – on his side after the accident. He pulled through emergency trauma surgery and, with the support of his family and medical team, began working toward recovery and his “new normal.”
Once stable, he transferred to a rehabilitation facility and learned how to perform the activities that would enable him to live as independently as possible without the use of his legs.
“We were 2012 state champs in baseball, and it’s that ‘practice how you play’ mentality that helped me,” said Caleb.
“I took every workout in therapy as seriously as I could, and that’s what got me through it.”
In the 18 months following his accident, Caleb underwent 15 operations, including several to replace failed hardware supporting his spine. In his last spine surgery, doctors installed hardware that extended from his pelvis to his neck. The solution was effective, but left Caleb with reach limitations.
BlueCare Tennessee Customer Service Representative Michelle Lawrence met Caleb and his father, Rodney, in person for the first time in 2016. “It’s so nice to meet our members, especially when you’ve worked with them for so long,” said Michelle.
Finding a device for greater independence
Despite the medical setbacks, Caleb persevered, graduating high school with his class and enrolling as a full-time student at Middle Tennessee State University. His remaining hurdle was his ability to manage his personal care program on his own.
Caleb’s father, Rodney, did extensive research, then worked closely with the rehabilitation facility’s team and the manufacturer to coordinate a trial of a system widely used in Europe. The system is fairly new in the U.S., and Caleb was the first adult patient at his rehab facility to use it.
“The device made a huge difference for me – I could take care of myself and live a pretty much normal life,” said Caleb.
Caleb’s family began paying for the system out-of-pocket and began the process of trying to get it covered by insurance. This would prove to be a more complicated challenge than they expected.
Because the system was so new to the country and not widely used by Americans, it didn’t even have a Centers for Medicare and Medicaid Services code until recently.
The lack of a code made it nearly impossible for any insurer to appropriately bill the government for its use.
Overcoming setbacks with advocacy
After hitting several roadblocks, Rodney connected with BlueCare Tennessee Customer Service Representative Michelle Lawrence, who had been assigned to Caleb’s case.
Lawrence worked tirelessly with Rodney over several months, coordinating efforts with external vendors as well as staff in multiple BlueCross departments.
Together, Lawrence and the team:
- Kept the authorization process on track
- Provided support with billing issues, and
- Worked with a medical equipment provider to get the system and its supplies fully covered for Caleb.
“Michelle has gone above and beyond to assist us in getting Caleb what he needs,” said Rodney. “It is encouraging to know that she is in Caleb’s court as an advocate.”
“I just did what I do every day,” said Lawrence. “I’ve gotten to know Caleb and his family, and to know he is able to live life independently and has what he needs to enjoy life, it’s just so rewarding.”
On the move
These days, Caleb’s routine looks a lot like any other college kid’s.
“In the morning, I work out, come back to my dorm for breakfast, get cleaned up, gather my materials, and head to class… try to make some good grades,” he says with a laugh.
Caleb stays active in a variety of sports, and his main activity is wheelchair softball.
“During the summer that takes up most of my time,” he said. “We did tournaments this year in Atlanta, Greenville, South Carolina and the national tournament in Biloxi.”
“I’ve had a lot of opportunities that I didn’t even expect to come out of this situation,” he said. “I’m just grateful to be here.”
