Couple Challenges Insurance Company, Overturning Decision That Would Have Denied Their Child Heart Surgery

| by Will Hagle

Brigette and Johan Schilling have a daughter named Aria, and she has been suffering from a life-threatening heart condition since she was born 15 months ago. Throughout most of the existence of Aria’s life, the Schillings have been working with a doctor that was recommended by their insurance company, Western Health Advantage, in order to get their daughter the surgery that her condition requires. 

According to the Huffington Post, the surgery was nearly cancelled when Western Health Advantage had “mistakenly referred them to a doctor at an out-of-network hospital, who they worked with for 10 months.” When the company realized the mistake, they promptly issued a notice to the couple claiming that they would refuse to pay for the surgery. 

This last-minute cancellation was potentially devastating for the family, as the doctor at the hospital they had been attending understood Aria’s health issues as well as her needs with the surgery. Western Health Advantage may have been willing to pay for a surgery at an in-network hospital, but that doctor would not have been as fully equipped to perform the procedure as the one with which they had been working. 

In a statement to FOX40, Johan Schilling explained that his insurance company cared solely about the profit that they would be making from the surgery, not about their daughter’s health.

“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. That’s very disappointing on a base level; it’s infuriating on another: the fact that they would make a dollar decision about my daughter’s care,” Johan said. 

In response to the insurance company’s refusal to pay for the surgery, the Schillings fought back. Their case became public after they spoke to the media regarding their appeal, which may have influenced the independent review panel’s ultimate reversal of Western Health Advantage’s decision. The couple was able to proceed with the procedure they had initially planned for with the primary doctor that the insurance agency had initially recommended. 

Johan’s wife Briggette expressed her joy for winning the case, claiming that she knew she had to fight in order to do what she believed was best for her child’s health.

“It was a tough road, a long, tough road. But it made me realize that we shouldn’t have stopped,” Briggette said. 

Aria’s heart surgery has not yet been scheduled, but it is expected to take place soon. At least the couple has achieved their first victory.