SAN FRANCISCO (KGO) — ABC7 is following a developing story after a retired San Francisco firefighter had his cancer treatment denied by Blue Shield. New information reveals he is not alone—other city firefighters have also faced denial of cancer treatments by the same insurance provider.
On Friday, current and retired firefighters gathered on the steps of San Francisco City Hall to stand in solidarity with one of their own: retired firefighter Ken Jones.
“This is unacceptable. Firefighters in California have a legal presumption that cancer is job-related. We earned that presumption through decades of exposure to toxic smoke, burning chemicals, and carcinogens — all contracted in the line of duty. Firefighter Jones upheld his end of the bargain. He served our city. He served our members. He paid into the system,” said Sam Gebler, president of IAFF Local 798.
A week ago, Jones attended the City and County of San Francisco’s Health Service Board meeting with his family, requesting the board’s intervention after Blue Shield, the city-provided insurer, denied his treatment for stage 4 lung cancer.
**Previous Coverage:** City asked to intervene after SF firefighter’s stage 4 lung cancer treatment denied by Blue Shield
Following media coverage, a Blue Shield physician reached out to Jones’ doctor. Together, they devised an alternate treatment plan that Blue Shield agreed to cover. However, Jones’ wife, Helen Horvath, notes, “It’s still an incomplete plan.”
Since Jones’ case came to light, it has spurred an investigation into similar denials. San Francisco’s mayor has pledged support to firefighters during this difficult time.
“You all always have our back, and we’re always going to have your back, especially when it comes to your health care,” said Mayor Daniel Lurie. “We will get to the bottom of this.”
According to the city’s Health Service Board, approximately 5,000 city employees and retirees are insured by Blue Shield. City leaders are now urging anyone who has been denied cancer treatment to come forward.
“We’ve heard of three other retired firefighters that are being denied cancer treatment by Blue Shield,” said Dean Crispen, Chief of the San Francisco Fire Department.
Tony Stefani, with the Cancer Prevention Foundation, shared concerning statistics about cancer in firefighters.
“Current statistics tell us that 65% of the men and women in our profession are going to contract some form of cancer in their lifetime. Some of them will be fatal,” Stefani explained. He also noted that firefighters diagnosed with cancer have a 14% higher chance of dying compared to other cancer patients in the general population.
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### Blue Shield Responds
In a statement, Blue Shield shared:
> “Our hearts go out to individuals and their families who are facing a cancer diagnosis or navigating treatment. We are committed to supporting our members with compassion and working with their doctors to help them access care and resources.
>
> For Medicare members, health plans must follow medical policy established by the Centers for Medicare and Medicaid Services (CMS).
>
> Our goal is to ensure members receive safe and effective care covered by Medicare.”
Blue Shield explained how Medicare works and outlined the steps their health plan must follow:
– Health plans are legally required to adhere to CMS criteria.
– All applicable state and federal regulatory requirements apply, including those set by the Food and Drug Administration (FDA) for prescriptions and treatments.
– Evidence-based guidelines from organizations such as the National Comprehensive Cancer Network (a not-for-profit alliance of leading academic cancer centers) are used.
– Reviews by qualified clinicians confirm whether treatment is safe, effective, and meets medical standards.
If the above criteria cannot be met, Blue Shield says it works with members and providers to help patients access approved or off-label treatments when permissible under Medicare rules.
Medicare members can file appeals directly with health plans and are entitled to an immediate, independent review by a qualified organization contracted with CMS. If the independent review disagrees with the plan’s denial, the plan must cover the treatment.
However, if CMS’s independent review determines the treatment is not clinically supported or covered under Medicare, the plan is also bound by that determination.
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### City Officials Take Action
San Francisco Supervisors Matt Dorsey and Connie Chan sent a letter to the San Francisco Health Service System demanding answers regarding Blue Shield’s decisions.
“We will utilize every possible tool in our toolbox to go after you. And we’re putting you on notice right now,” Chan said.
Supervisor Dorsey, who is a commissioner on the board that approved switching city workers from United Healthcare to Blue Shield last year, acknowledged the growing regret over the switch.
When asked what the board could do, Dorsey replied, “We would actually probably go to our city attorney and take a look at the agreement and see if there is some breach of the agreement.”
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For those impacted by Blue Shield’s denials of cancer treatment, city leaders encourage speaking out to ensure these cases are addressed.
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For ongoing updates, stay tuned to ABC7 News.
https://abc7news.com/post/san-francisco-firefighters-rally-retiree-denied-cancer-treatment-blue-shield-more-patients-come-forward/18418411/
