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Family Pleads for Baby's Heart Surgery After Insurance Denial Four Days Before

One local family is holding onto hope that their Western Health Advantage healthcare will cover their baby's open-heart surgery, after an insurance slip-up caused a claim denial — just days before Aria Schilling's procedure.

Save Aria has gone viral on Facebook as her family hopes to put pressure on their insurance carrier to cover her heart surgery.
Save Aria has gone viral on Facebook as her family hopes to put pressure on their insurance carrier to cover her heart surgery.

If you are friends with more than a couple of people in Dixon, chances are, your Facebook feed is flooded with Save Aria photos. What you will find behind the photo campaign, and those big brown eyes, is her parents' shocking battle with their health insurance carrier.

Aria Schilling, 13-months-old, daughter of Cynde’s Place Hairstylist, Briggette Schilling, has been battling a heart condition most of her life, diagnosed in February 2013. Now, six days before her open-heart surgery, her health insurance company is changing its mind on her coverage.

Most parents could not imagine having to choose a doctor to trust working on their baby's heart, but to have surgery planned and then authorization revoked just days before, due to an insurance company slip-up, would be unfathomable. That is what this local family is dealing with this week.

“She has ventricular tachycardia, pulmonary Artery stenosis, vsd, murmur, and we are waiting for a final diagnoses of Noonan Syndrome,” Schilling explained to Patch, “We started planning her surgery Aug. 15 with the doctor our insurance carrier, Western Health Advantage (WHA), referred us to for a second opinion, because we were receiving inadequate care pertaining to her heart condition at UC Davis Medical Center.”

She explained that now, months later, WHA admits it mistakenly sent her to a doctor that works at a non-contracted facility, Oakland Children’s Hospital.

“They referred us to this doctor, never telling us that the hospitals our doctor is contracted with are out of network, they admitted the mistake,” Schilling said, “Someone dropped the ball!”

Aria is scheduled for a catheter procedure Tuesday and open-heart surgery on Thursday, and Schilling says they received the official denial on Friday via FedEx.

Not knowing where else to turn, the Schillings called local media to put pressure on the insurance company. Since Friday, several news channels have covered the story (watch the News 10 interview here) and dozens have sent letters and comments to WHA.

“They [WHA] brought in a case manager on Saturday, she told us that we got the attention of the bigwigs, and they didn't expect we could reach so many people. We have appealed the denial and filed a grievance,” Schilling explained, “We are hoping to rattle enough cages that they will allow the procedures to be covered this week.”

If Western Health Advantage refuses to cover the procedure now, it could be months before a new doctor can evaluate Aria and schedule a new surgery. Aria’s condition is causing the artery in her lungs to slowly close, and her parents worry her condition will only worsen if the process is restarted.

The family is asking the public to help put pressure on the insurance company by adding a comment on their public Yelp page here.

Bil Paul October 07, 2013 at 04:36 PM
Why did WHA deny the procedure this time around? Wasn't it covered under their declaration of coverages?
Kassi Kosydar Sedgwick October 07, 2013 at 04:56 PM
Remember, if you post a review on www.yelp.com for Western Health Advantage, you have to do it in first person. Yelp does not allow reviews to remain if they are third party. Western Health Advantage does not want to fork out money for this top notch cardiologist! They would rather the surgery be performed at their network hospital, UC Davis - which is the very hospital that could not diagnose Aria or treat her, in the beginning of this journey!

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