A California couple is celebrating today after winning a battle over insurance coverage for their toddler's heart surgery.
Briggette and Johan Schilling's 14-month-old daughter, Aria, was born with a hole in her heart and a deformed valve. The girl was scheduled to have open-heart surgery Oct. 11 at Children's Hospital and Research Center Oakland. But Western Health Advantage, the family's insurance provider, denied coverage for the surgery since the hospital and cardiologist were out of network.
Briggette Schilling said she was shocked by the last-minute denial since Aria's case manager, assigned to her by Western Health Advantage, knew she was being tested at the Oakland hospital and never mentioned that it was out of network.
"I said, 'I don't think you realize who I am or how I am, and I will fight this 'til the end,'" Briggette Schilling told ABC affiliate KXTV.
The Schillings tried to appeal the insurance company's decision but were denied. So they took their case to California's Department of Managed Health Care, KXTV reported, and found out Friday that an independent review panel took their side and overturned the denial.
"It was surreal," Johan Schilling told KXTV of the moment he heard the news. "I actually had to pull off on the side of the freeway, and I was crying because it was a tremendous sense of relief."
A surgery date has yet to be set, KXTV reported. But Aria is expected to have several weeks of recovery after the operation, and she might even need additional procedures.
For now though, her parents are glad the insurance battle is over.
"It was a tough road, a long, tough road," Briggette Schilling told KXTV. "But it made me realize that we shouldn't have stopped."
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.
- Disease & Medical Conditions