Calvin “Elijah” Briggs Jr. was building a career around telling stories.
The 23-year-old Birmingham-area native graduated from Clark Atlanta University earlier this year with a degree in film. He also worked as a docent at the Birmingham Civil Rights Institute.
His goal was to use animation to make Birmingham’s history and the Civil Rights Movement accessible to people who might not otherwise engage with it.
His mother, Samantha Briggs, described him simply as “light.”
“Elijah is like super goofy and fun, and you just want to be around him,” she said. “He’s just light and euphoric and just happy.”
But on July 1, his life changed.
A brain injury
Samantha said she woke up in the early morning hours after hearing noises coming from Elijah’s basement bedroom.
She eventually heard him take a deep breath and found him having what doctors later determined was a seizure.
He was taken to Grandview Medical Center, where doctors discovered an arteriovenous malformation, an abnormal collection of blood vessels, had ruptured.
Samantha said the rupture led to a seizure, which caused Elijah to fall and suffer a head injury. The resulting bleeding caused a stroke.
He was airlifted to UAB Hospital, where he underwent emergency brain surgery. Doctors then placed him in an induced coma for several weeks.
When doctors began reducing his sedation, Samantha said the family expected him to wake up quickly. Instead, his recovery has been slow and inconsistent.
“There are days where Elijah is more alert than others,” she said. “He’s moving his arms and his hands, and responding to commands in immediate time.”
She said he can sometimes follow commands, wiggle his fingers, grasp and release a hand, and give what the family calls a “long blink yes.”
Other days, he may sleep or respond only with his eyes.
Doctors describe that condition as a disorder of consciousness.
A specialized kind of rehabilitation
Doctors said Elijah needed rehabilitation specifically for people who are emerging from severe brain injuries but do not consistently meet the requirements for traditional inpatient rehabilitation.
There is no specialized disorders of consciousness rehabilitation program in Alabama, according to his family.
That led them to TIRR Memorial Hermann in Houston and its Disorders of Consciousness Rehabilitation Program. Samantha said that kind of care could be critical for Elijah.
“Using devices that even somebody like an Elijah, who’s in a semi-conscious state, they can put him on a device where he’s standing upright,” she said. “But stimulating and moving his body in ways in which are most familiar and are most compatible with a full emergence and recovery.”
TIRR accepted Elijah after reviewing his medical records.
But there was problem.
His insurance company would not pay for the treatment.
Three denials
Blue Cross and Blue Shield of Alabama denied coverage three times, according to the family.
The reasons changed.
At one point, the insurer said it did not cover sensory stimulation for people described as being in a “comatose or vegetative state.” Samantha said that description did not match what she was seeing with her son.
She pointed to his ability to respond to commands and his progress with swallowing. Elijah had also been cleared to have liquids in addition to his feeding tube.
With the third denial, the family was told Elijah no longer needed to remain at UAB Hospital. Samantha said the family was essentially left with two options: nursing home care or taking Elijah home.
A powerful insurer
The fight over Elijah’s care came as AL.com reporter Savannah Tryens-Fernandes was investigating a broader question: how much influence does Blue Cross and Blue Shield of Alabama has over health care access in the state?
Fernandes said Elijah’s case stood out because of the language in the family’s initial denial.
“Blue Cross said that their denial was given on the basis that his treatment was investigational,” Fernandes said.
Blue Cross has said coverage decisions are based on established clinical guidelines, published medical research and accepted standards of care. When a treatment does not meet those criteria, the company considers it investigational.
Fernandes said providers told her that when a treatment is considered investigational, it can become extremely difficult for patients to access it, even when doctors recommend the treatment.
Beyond that, Blue Cross' dominance of Alabama’s private insurance market gives the company significant leverage in negotiations with hospitals and providers. She said that influence can affect what treatments are available to patients, particularly when a provider believes an insurer will not pay for a service.
A chance to recover
The Briggs family appealed Blue Cross' denials and continued pushing for the specialized rehabilitation program in Houston. A UAB neurointensivist wrote a letter supporting the appeal saying Elijah still had an opportunity to regain consciousness and some abilities.
After the appeal and media attention, Blue Cross and Blue Shield of Alabama reversed its decision and approved coverage.
Fernandes said she cannot establish that her reporting caused Blue Cross to reverse its decision. The company does not comment on individual cases because of patient privacy. But the approval means Elijah can move forward with the treatment his doctors and family have been seeking.
The Briggs are in Houston the week, where Elijah will receive specialized rehabilitation focused on improving alertness, communication, swallowing and movement.
Samantha Briggs said the family understands the program does not guarantee a particular outcome. Nor do they know how much Elijah might recover.
But she says he deserves the opportunity to find out.
“The doctors still believe that it’s possible,” Samantha said. “We do know that he deserves the greatest chance ever.”
Blue Cross and Blue Shield of Alabama is a program sponsor on WBHM. But our news and business departments are editorially independent.
