Cheri Johnson

In his turquoise blue eyes and wide grin, T.J. is still T.J.

The 18-year-old still loves hip-hop music, vintage clothes and fishing with his dad. He’s still sociable, quick to make a joke and to laugh.

But 21/2 years after the car accident that he wasn’t supposed to survive, almost everything else is different about T.J. Johnson’s life.

The Central High School senior must be lifted into his bedroom and bathroom because his wheelchair can’t fit through the door frames. He speaks slowly and in fragments, and he has relearned how to eat and hold his head up. But his progress toward walking again has stalled: He’s waiting to find out whether his insurance will cover more physical therapy.

At night his mother fends off dreams of the accident scene she never saw, and she struggles to understand why it happened.

“I been trying to find reason and rhyme for this, and I can’t find any,” Cheri Johnson said last week in her living room.

She can’t understand why her mother and her youngest son, Ryan — then 15 — had to be there to witness a truck plow into T.J.’s van as they sat at a stop sign across the street or why her youngest had to be the first one to him, holding his brother’s head until the paramedics arrived.

Bankrupted by their share of $700,000 worth of medical bills, the Johnsons were forced to sell their home in Soddy-Daisy when they couldn’t make the payments to avoid foreclosure.

“We’d always lived in mobile homes, and it was the first house we ever had,” said Mrs. Johnson, who works at Citizens Savings and Loan in Hixson. The family now rents a house in Harrison.

Navigating the health care system has been overwhelming, according to his family and caregivers.

BOUNCING BACK

After the November 2005 accident, T.J. was in a vegetative state for nine months — eyes open, but unaware of his surroundings.

He didn’t have any broken bones — just some scratches on his face, his family said. But brain damage left him with severe motor and cognitive impairments, including short-term memory loss.

Likely because of to low-blood pressure and low-oxygen levels after the accident, his brain has atrophied in areas associated with memory formation, the same areas that shrink in patients with Alzheimer’s, said Dr. Matthew Kodsi, T.J.’s neurologist with Chattanooga Neurology Associates. Excess fluid in the brain after the accident also caused a generalized brain injury, he said.

“People with those types of injury don’t generally have a good recovery,” he said. “But people at a younger age tend to bounce back a little better.”

T.J. spent months in intensive care at Erlanger hospital, then had 30 days of nursing care at Shepherd Center in Atlanta before his family brought him home.

Doctors at the time weren’t optimistic.

“They more or less told us to put him in a home, that he’d be a vegetable the rest of his life,” Mrs. Johnson said.

But in mid-2006, T.J. began to come around. First he spoke a bit, and he began to recognize the people around him, his family said.

Speech, occupational and physical therapy at Siskin Hospital for Physical Rehabilitation through half of 2006 and most of 2007 brought about improvements in his communication, short-term memory and strength, his family said.

“I loved it,” T.J. said this week, “because they helped me walk ... and move my arms.”

But in January 2008, Mrs. Johnson got a call from Siskin saying that T.J. would have to stop getting therapy there.

T.J. is covered by his mother’s insurance policy, United Healthcare, which pays more if a patient uses medical providers that are part of the company’s network. Siskin is not in the network, so it received less reimbursement for T.J.’s therapy, said Siskin spokeswoman Teresa Dinger. At this point, Siskin has absorbed about $30,000 in costs for T.J.’s services and can’t afford to absorb more, she said.

In another roadblock, United bases its payments for rehabilitation care on whether the care is a “medical necessity,” Siskin officials said. Although T.J. made progress during his rehab, by United’s standards his rate of improvement would probably not justify more sessions, so future therapy sessions would not be covered at all, Siskin administrators believe.

“Somebody can be progressing, and possibly be able to walk in the future, but the insurance company sees a lot of these things as maintenance,” said Tod Cain, administrative director of therapy services. “To certain insurance companies, progress does not necessarily equate to medical necessity.”

United Healthcare officials said Friday they did not have enough time to respond to a media inquiry made late afternoon Wednesday.

“We’ve simply not had enough time to be able to evaluate and analyze the circumstances of this case,” said Roger Rollman, a spokesman for the insurer’s Southeast region, noting that the insurer needs at least three to five days to investigate a case.

Debby Barker, director of Siskin’s outpatient business office, said visits to Siskin’s Fitness Center would be an alternative way for T.J. to maintain the progress he had made in therapy.

“When you’ve got people here as long as he and his mom and dad, they formed relationships with everybody,” she said. “The last thing in the world we want to do is cut him off if he’s making substantial progress.”

The break in therapy sessions has been hard on the family, and disappointing for T.J.

“It makes me feel that I did something wrong,” he said.

“I have something to fight for. He could really walk,” Mrs. Johnson said.

Amy Denton, a caseworker at Home Health Care of East Tennessee, said she has some leads on other options for the family and is working with a TennCare caseworker to figure out what the state’s managed Medicaid program should cover for T.J., who qualifies for TennCare as secondary insurance. Ms. Denton said TennCare will cover services at an in-network rehab hospital if United denies the visits.

In the meantime, T.J. goes to school at Central High School for an hour a day and has speech therapy there twice a week. TennCare is paying for a certified nursing assistant to stay with T.J. eight hours a day, five days a week.

The family said they are grateful for the help they are getting, though they are anxious for modifications to their home — specifically T.J.’s bedroom and their bathroom — which would allow T.J. more independence.

MAKING ADJUSTMENTS

On the wheelchair ramp outside their house, T.J.’s father, Tim, ruffles the boy’s sandy hair before they head out to go fishing.

Mr. Johnson repeatedly and gently nudges his son’s head to the right when it begins to fall to the side. He sternly tells him to slow down and speak clearly, when T.J.’s words slur. T.J. takes a breath and starts again.

“There’s no sense treating him any different or taking anything away from him,” his dad said. “I try to do everything that we once did. He was my buddy.”

T.J. speaks about his prom last weekend, which he attended with his brother and cousins, decked out in a pink-and-black tuxedo. He said he “cut a rug” and that he loves going to school. He also loves hunting, fishing, swimming — “outdoor stuff.”

They’re still waiting for van modifications that would accommodate the power wheelchair provided by TennCare, but that’s unavailable until T.J.’s vocational rehabilitation coverage kicks in, which won’t happen until he graduates and figures out what kind of work to do, said Tennessee Department of Human Services spokeswoman Michelle Mowery Johnson.

The next step for him is graduation from Central High School on May 17. Though T.J. won’t be able to walk across the stage alone, as he had hoped, Mr. Johnson and T.J.’s brother plan to support him on either side so he can cross the stage on his feet.

“Years ago, I told the boys that they only owe me three things in life — one of them was graduation,” Mrs. Johnson said. “He’s going to have a diploma that more or less says, ‘Yes, he did graduate.’”