The gentle gaze of Aria Schilling’s big, soft brown eyes don’t show the strain of the health insurance tug of war she’s caught in the middle of. The 13-month-old Vacaville girl has been sick since birth with a heart condition that requires surgery.
“She has a problem with the way her heart beats, she has holes in her heart. She has a heart murmur and she has an artery problem where there’s a blockage building up which is the artery that goes from the heart to the lung,” said Briggette Schilling.
The Schillings’ insurance company, Western Health Advantage, sent them to UC Davis Medical Center. Aria’s parents were unhappy with their daughter’s doctors and wanted a second opinion. They tell FOX40 that’s when Western and a case manager sent them to Oakland Children’s Hospital – Briggette and Johan Schilling grew to love and trust the doctor’s there – with their daughter’s life.
A week before Aria’s surgery, Western said Aria’s doctor of ten months – the one Western referred – was out of network and they wouldn’t pay for her life saving surgery with him, though they’ve paid every other bill.
“We had no inkling there was a denial pending. It literally knocked the breath out of me when I had a phone call from our cardiologist state what Western Health Advantage was about to do, “ said Mom Briggette.
For it’s part, Western says they won’t comment on Aria’s case without signed HIPAA release documents from the family, but did send an e-mail to FOX40 saying this:
“WHA maintains a provider network of over three thousand physicians and 14 hospitals that provide necessary services and procedures to our members. If a service cannot be performed in the network, we make referrals to specialists outside of the network. This process is actively managed between WHA, our providers, and our members.”
“Really, it’s a dollar amount. It’s not because the hospital can’t do the procedure, it’s because it’s not in-network. It’s disappointing on a base level and it’s infuriating on another that they could make a dollar decision about my daughter’s care,” said Johan Schilling.
Aria’s surgery was scheduled in Oakland for this week.
“If she waits a year, we would probably end up in the ER or her passing. We can’t wait a year. We were told that precisely,” said Briggette.