VACAVILLE, CA - A family locked in a dispute with their HMO over their daughter's heart surgery is hoping a deal may be worked out.
Aria Schilling was born with several rare heart problems that will require a complex surgery, an operation her parents said she needs to have as soon as possible.
The family's cardiologist had planned the surgery at Children's Hospital Oakland, an out-of-network hospital for the Schilling's provider, Western Health Advantage.
But last week, just days before the surgery date of Oct. 10, Western Health Advantage informed the family the surgery would have to be cancelled.
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"Just the emotional toll, to think we're gonna have to do it all over again. I can't even tell you," said Aria's mother Bridgette Schilling while holding back tears at their Vacaville home Wednesday.
It's not clear why the cancellation from Western Health Advantage came so late, but the Schillings said their pediatric cardiologist recommended the surgical team at Children's Hospital Oakland and that they want the surgery to take place there. But, the Schillings' provider wants the surgery done in-network at UC Davis Medical Center.
Western Health Advantage said it cannot comment because of federal regulations involving patient privacy.
Western Health Advantage has offered to discuss the case with the news media if the Schillings give their permission, but the Schillings declined. The family previously asked the HMO to comment on the case, but were turned down. The couple said they now worry the provider would make comments that might discourage a positive resolution.
The Schillings said their cardiologist is now trying to see if Children's Hospital Oakland will reduce their charges for the surgery.
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"Our doctor even says he's willing to negotiate with Children's Hospital on our behalf to try to come up with a contractual agreement where they would work on an in-network price," Aria's father Johan Schilling said.
The couple has also taken their case to the State Department of Managed Healthcare and said the agency may make a decision on their case as soon as Friday.
"We're just trying, so desperately, to hold on for hope that they will change their mind and reverse the denial," Johan Schilling said.