Blue Shield, a major health insurance provider, is facing criticism after denying coverage for crucial treatment for Ken Jones, a former San Francisco firefighter who recently passed away from lung cancer.
Ken, who fought a tough battle against his illness, passed away at the age of 71 on Saturday, just over a year after being diagnosed with stage 4 cancer.
“I really think they hastened his death,” stated Janine Nicholson, a friend and former fire chief in San Francisco. “They should feel ashamed of themselves.”
Having worked with the fire department for 17 years, Jones was among approximately 5,000 city employees and retirees covered by Blue Shield, which has substantial contracts with San Francisco.
In January, unable to get the necessary treatment approved, Jones turned to the city for assistance after Blue Shield denied coverage for some of the treatments suggested by his oncologist.
This situation prompted public outcry, leading members of San Francisco’s Board of Supervisors to question the executives from the insurance company about their claims process.
Blue Shield claimed that their denial was based on medical guidelines that did not support the requested combination of chemotherapy and immunotherapy.
In a statement, Blue Shield expressed that they were “deeply saddened” to hear about Jones’ death and mentioned plans to discuss potential changes with fire union leaders and advocates.
Dr. Matthew Gubens, Jones’ oncologist, disagreed with Blue Shield’s assessment. He attempted to appeal the denial of care in writing, but was unsuccessful.
“Medicine often has gray areas,” he noted. “The time spent seeking approval was crucial as Ken was losing ground—his tumor was growing, and he was experiencing increased pain and a diminished appetite.”
City supervisors indicated plans to bring Blue Shield back for updates regarding their reform initiatives.
Following the public backlash in January, Blue Shield created another, albeit incomplete, plan to assist Jones’ wife, Helen Horvath.
However, friends of Jones believe that more timely care could have prevented his death.
“Insurance companies need to be held accountable,” Nicholson emphasized. “Their priority is profit, not necessarily providing the best care to those in need.”
