Family Hoping For Deal in Daughter's Heart Surgery

Oct. 11, 2013— -- A California family is hoping a last minute deal will help their toddler daughter get vital heart surgery after their insurance company denied the procedure just days before it was scheduled.

Briggette Schilling's said her daughter, Aria, was born with a hole in her heart and valve deformity that will need open heart surgery to fix.

Since January, the Schilling family has been taking Aria, now 14 months, to be treated at the Children's Hospital and Research Center Oakland and Aria's surgery was scheduled to take place there today. But a week before the surgery was scheduled, the Aria's health insurance provider, Western Health Advantage, denied the procedure since it was out of network.

"I will say this, that the pain and suffering is horrendous. I've never had so much anxiety in my life," said Schilling. "[It's one thing if it's me,] it's another thing if it's about my child."

Melinda Krigel, a spokeswoman for Children's Hospital and Research Center in Oakland, confirmed that the insurance company had denied the procedure the week before the surgery was scheduled.

Krigel said that Aria's cardiologist, Dr. Alok Bose, worked with the hospital to offer an in-network price for Western Health Advantage for the surgery, but that the insurance company still wanted the family to take Aria to an in-network specialist.

Schilling said she was shocked about the denial since Aria's case manager, assigned to her by Western Health Advantage, had never mentioned that her cardiologist or hospital was out of network.

According to Schilling, the case manager was aware for months that Aria was undergoing testing at the Oakland hospital in preparation for the surgery.

"When you have a child that's been sick and you're trying to manage day by day, you think the doctors, nurses and case managers are doing their job," said Schilling.

Surgery Before Birth Saves Baby

Schilling has not signed a release form that would authorize the insurance company to talk about her case in public. A spokesman for Western Health Advantage said without the family signing a release they were unable even to confirm that Aria is on their health plan.

A spokesman for Western Health Advantage said that the company has a network of over 3,000 physicians and 14 hospitals and medical centers. In addition, they said they have 6 cardiothoracic surgeons at UC Davis but it was unclear how many of them would take pediatric cases.

Although Schilling said Western Health Advantage wanted Aria to be treated at the University of California Davis Medical Center, the Schillings were concerned about the level of care she would receive.

According to Schilling, Aria had initially been treated at UC Davis when her heart problems started, but they disliked the medical unit and transferred to the Oakland hospital.

"It would be putting us back in the same unit that we were [initially] referred to, that we got away from," said Schilling.

Schilling said she will meet with the one cardiothoracic surgeon in network later this week. Schilling is concerned that the doctor would not know her daughter's case and that she would not have other options in case she did not like the recommended surgeon.

"[They said] They're going to fast-track this. I don't know any mom that wants to fast track their daughter's open heart surgery," said Schilling.

Requests for a comment from the University of California Davis Medical Center were not immediately answered.

An additional problem is timing Schilling said. It could take a month to reschedule the surgery. However if Aria gets sick with a cold or flu the surgery will be delayed at least six weeks as a best case scenario, her mother said.

Schilling said the family is hoping the surgery will be rescheduled soon, since she thinks Aria's condition will deteriorate more severely in the next six months.

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