Blue Shield blasted for denying treatment after retired SF firefighter dies

Health insurance giant Blue Shield is under fire for denying claims of life-saving treatment for a retired San Francisco firefighter who recently died from lung cancer.

Ken Jones, who was in a bitter insurance fight that caught the attention of local outlets, died Saturday at 71 more than a year into his stage four cancer diagnosis.

“I believe, wholeheartedly, that they expedited his death,” Jeanine Nicholson, the former chief of the San Francisco Fire Department and a friend, told NBC Bay Area. “They should be ashamed.”

Jones spent 17 years in service, and Blue Shield is one of three insurance companies contracted by San Francisco at a cost of more than $1 billion. According to San Francisco’s Health Service Board, about 5,000 city employees and retirees are insured by Blue Shield. 

But Jones had to go to the city for help in January when Blue Shield denied coverage of some of his recommended treatments.

His pleas prompted public outcry and led members of San Francisco’s Board of Supervisors to summon top leaders at the insurance company to grill them on their claims approval process.

Blue Shield repeatedly argued that in Jones’ situation, the denials were due to medical guidelines that did not support the combination of chemotherapy and immunotherapy Jones’ oncologist requested.

Blue Shield is “deeply saddened” to learn of Jones’ passing, it said in a statement to NBC. The insurance giant will reportedly be in talks with firefighters’ union leaders and other advocates about potential reforms.

Dr. Matthew Gubens, the oncologist, has claimed Blue Shield’s interpretation is wrong. He tried to appeal the claim denial in writing but was denied.

“There’s gray area in medicine,” he had told NBC Bay Area. “The time spent trying to get approval of a regimen that I requested, [Ken] lost ground – tumors are growing, pain is increasing, his appetite is going down.”

City supervisors have said they will bring back Blue Shield to get an update on any efforts to implement reforms.

After the public attention in January, Blue Shield did eventually figure out a different but incomplete plan that it would cover, Helen Horvath, Jones’ wife, told ABC7.

But his passing, which may have been prevented with more timely care, is something that can’t be reversed, Jones’ friends said.

“We need to hold insurance companies accountable for their actions,” Nicholson said. “They are in the business of making money. They are not always in the business of giving people the best care or the care that they deserve.”

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