Plano Man Faces 'Out-of-Network' Surgery, Calls NBC 5 - NBC 5 Dallas-Fort Worth
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Plano Man Faces 'Out-of-Network' Surgery, Calls NBC 5

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    Plano Man Faces 'Out-of-Network' Surgery, Calls NBC 5

    A man in Plano said he needed a life-changing surgery to keep him from becoming paralyzed. But he said his insurance company wrongfully processed his doctor as "out of network," meaning he'd have to pay about $80,000. NBC 5's Samantha Chatman Responds. (Published Thursday, July 18, 2019)

    Sitting on the couch with guitar in hand is Jeff Krzeszinski's place of peace.

    "I found it very therapeutic," he said. "It helps me focus."

    But his strong relationship with his guitar was one that would eventually change.

    "I couldn't feel my strings on my fingers," said Krzeszinski. "I was losing the feeling in both hands and up this right arm which had a lot of hot, burning, pain, shooting sensation." 

    Several years ago, the military veteran said he was involved in a crash that nearly claimed his life.

    He said he was one of seven who made it out alive.

    Krzeszinski survived, but said his body took a beating with several broken bones and a spinal injury.

    Over time, his problems returned.

    "With the MRIs, the doctor pointed out my spinal fluid was cut off and my disk was pressing against the spinal cord."

    Krzeszinski was told he needed neck surgery.

    "The doctor said get it quick before it gets worse, or even worse make the wrong move and be paralyzed," Krzeszinski explained.

    But when he scheduled the surgery, he said there was a problem.

    He said his insurance provider, Blue Cross Blue Shield, wasn't processing his doctor as in-network, despite paperwork that his physician had filed proving he was in-network. 

    The cost of the surgery, he was told, would be at least $80,000.

    "$80,000 plus and out of pocket. No, I wouldn't have been able to pay for that. That's insane," he said. "I've seen the results that you get. Many different issues and I thought, I'll give it a shot. You don't know if you don't try."

    A spokesperson for Blue Cross Blue Shield told me they don't comment on individual member's situations., and that their top priority is to provide access to quality, cost-effective healthcare for their members.

    "We work on behalf of our members to make sure they receive the right care, at the right place, at the right time," the spokesperson added.

    "About 3 hours later they called with an approval for the surgery. I was elated," said Krzeszinski.

    He said Blue Cross Blue Shield processed the doctor as in-network.

    Krzeszinski had the surgery the following week.

    He's still recovering, but fortunately his bills have only come out to about $500.

    "It was really amazing," he said. "The local news lady coming to the rescue."

    His new focus is healing his mind and spirit, with the help of his guitar.

    Krzeszinski told me his recovery is going better than expected, and he hopes to play his guitar again soon.

    If you believe your doctor is in-network, but was billed out-of-network, you can submit a complaint with the Texas Department of Insurance here.

    Before treatment, be sure to always ask your doctor if he/she is in-network with your insurance. 

    As for the anesthesiologist and radiologist, you may want to check with them, too.

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