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REALITY CHECK: Insurance nightmare - Florida approves, Alabama denies

(IMG: WPMI)

NBC 15 Reality Check gets results for special needs child after an insurance nightmare.

For months a Mobile County family has been fighting their insurance company trying to get a speech device covered for their special needs son. In this Reality Check, NBC 15's Andrea Ramey explains how the deck is stacked against working families, and days after stepping in gets results for one family.

Jumping on his trampoline is a major accomplishment and a favorite pastime for Carter Cox.

"We didn't know if he would ever walk when he was diagnosed," said his mother Erica Cox.

The beaming, brown-eyed 10-year-old was born with Phelan-McDermid Syndrome.

"It's extremely rare," said Erica.

Lately, it's his parents, Erica and Ryan, who are doing more of the jumping through hoops trying to get their insurance company to pony up the cash for a speech device. With Carter's condition, he can't talk.

"We don't know his thoughts, and that's probably the most gut wrenching part of it is just not knowing what he's thinking or feeling," said Erica.

The Cox family pays $13,000 a year for health insurance premiums and thousands more out of pocket for therapies. Last year, Blue Cross Blue Shield told them it would only cover a fraction of the speech device - $1,000 for a device that costs $7,500.

"It doesn't seem fair," said Ryan Cox.

"What 's so sad is if my husband and I were to get a legal separation. Carter would qualify for everything. He would get disability. He would get Medicaid. All these things would be covered because I'm a stay at home," said Erica.

For families who make too much to qualify for Medicaid and have children with permanent disabilities, that's where something called a Medicaid waiver can help fill the gap. In Florida, children born with Phelan McDermid Syndrome automatically get one.

"The benefit of a Medicaid waiver is when this happens, it falls to Medicaid," said Ryan.

In Alabama, it's not so simple. One kind of Medicaid waiver that would cover speech devices has limited slots - 5,260. And the wait is long. Currently 2,329 people are in line.

"I feel like I'm just running into a wall, just back and forth running into a wall," said Ryan. "It's always a fight and it shouldn't be a fight."

"The state of Alabama doesn't have great benefits for kids like Carter," said Erica.

NBC 15's Andrea Ramey reached out to Blue Cross Blue Shield last week. On Tuesday, the vice president of corporate communications promised to "look into this." Three days later, Ramey got another email saying the "issue has been resolved." The Cox family also received good news Friday from BCBS assuring them they would now cover the device.

Are you having a problem with an insurance or hospital bill? NBC 15's Andrea Ramey would like to know. Send her an email aramey@sbgtv.com

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