VACAVILLE -A Vacaville couple successfully waged a fightagainst their HMO to get their toddler daughterlife-saving heart surgery. Now they want to share the lessons learned with other parents.
Aria Schillings will keep herheart surgeon and have the operation at the hospital her family wanted. It was a long struggle.
Last month News10 reported the Schillings' fight for their daughter after their HMO refused to let the surgery go forward at a hospital out of network. That set the stage for a battle that received international attention.
Someday,Ariawill learn why no one should mess with her mom.
"I said, 'I don't think you realize who I am or how I am, and I will fight this 'til the end,' and I told her I am fierce. It's my child. I am fierce," Briggette Schilling recalled.
That's what the mother told her case manager at Western Health Advantage when the HMO said Aria couldn't have heart surgery at Oakland Children's Hospital because the medical center is outside of their network.
The Schillings chose their surgeon and hospital on the advice of their doctor, and they were convinced the alternative their insurer offered was not good enough.
On Friday, they got the news an independent review agreed, writing, "I have determined that the requested services are medically necessary ..." The review concluded "the Health Plan's denial should be overturned."
"It was surreal. I actually had to pull off on the side of the freeway, and I was crying because it was a tremendous sense of relief," Aria's father Johan Schilling said.
"It was a tough road, a long, tough road, but it made me realize that we shouldn't have stopped," Briggette added.
The Schillings hope other parents will realize they have options if they're denied certain treatments. They began by filing appeals, but those were denied. Their next step was California's Department of Managed Health Care.
"And what happened in our case, they found enough discrepancies between the individual doctors' notes and plans for procedure that sent it out because there was kind of a red flag on, wait a minute, it was significant enough to not even be comparable," Briggette said.
But the Schillings had to do their homework, and while they're grateful for the outcome, it scares them to think what could have happened to their daughter Aria if they hadn't learned a lot in a short amount of time.
"We've learned a lot about congenital heart defects. We're learning a lot about genetic disorders," Johan said.
"We're learning a lot about health insurance plans," Briggette said.
"We've learned a lot about health insurance plans, and we're all learning as a country right now about health insurance plans," Johan continued.
The family expects to learn early next week when they can schedule Aria's surgery. She'll have several weeks of recovery, and she has additional heart problems that will require more treatment, but for now her parents say they're grateful that this debate is over.