Blue Shield Denials Hit San Francisco Firefighters
A veteran San Francisco firefighter’s battle against Stage 4 cancer has triggered a government hearing aimed at exposing how often Blue Shield of California denies medical claims for the city’s more than 40,000 employees and retirees. The case has drawn widespread outrage and now demands answers from one of California’s largest health insurers.
A Firefighter’s Fight for Cancer Care
Ken Jones dedicated 17 years of his life to the San Francisco Fire Department. Today, he is fighting Stage 4 lung cancer — and fighting his own insurance company at the same time.
Blue Shield of California approved Jones’s chemotherapy but denied his immunotherapy. His oncologist, Dr. Matthew Gubens, prescribed the immunotherapy to bolster Jones’s immune system and slow the disease’s progression. Blue Shield determined that Jones did not qualify for the treatment based on the stage of his cancer.
The Doctor Disagrees
Dr. Gubens is not just any oncologist. He helped craft the very clinical guidelines Blue Shield used to deny Jones’s care through his work with the National Comprehensive Cancer Network. Moreover, he believes the insurer misread those guidelines.
“There are gray areas among our patients where those guidelines just don’t apply,” Gubens explained. “We have to make clinical decisions on the ground.”
Jones told NBC Bay Area investigators how devastating the denial felt. “You just automatically depend on that insurance being there,” he said. “Then, when it’s not, it’s quite a blow.” His story has since drawn thousands of responses online — many from people who recognized a troubling pattern.
The Government Hearing That Followed
In response to the NBC Bay Area investigative series on Jones’s case, San Francisco Supervisors Connie Chan and Matt Dorsey requested a formal government hearing. Their goal is straightforward: understand how frequently Blue Shield and other city-funded insurers are denying claims to public employees.
Supervisors Speak Out
Supervisor Chan, whose longtime partner has served as a San Francisco firefighter for 15 years, did not hold back. “Their care is being denied — that is unacceptable,” she said. “Public dollars cannot go to these companies while they can deny care to line up their bottom lines and their profits.”
Furthermore, Chan confirmed she will push for a mandate requiring insurers to disclose claim denial rates to the city. “We want to understand the percentage of claim denials and why,” she stated.
Supervisor Dorsey, who represents SoMa and Mission Bay, co-sponsored the hearing request alongside Chan.
Blue Shield’s Record on Claim Denials
Blue Shield, Kaiser Permanente, and Health Net collectively received more than $1 billion from San Francisco last year to insure city workers and retirees. Despite this enormous public investment, the city has never had access to data on how often Blue Shield denies claims.
What the Data Does Not Reveal
NBC Bay Area’s Investigative Unit requested those denial records from the San Francisco Health Service System. Officials confirmed the city has never received that information from Blue Shield or any other insurer.
Statewide, concerns about Blue Shield’s denial practices are not new. According to Providence Health, Blue Shield denials rose 11.7% in 2024 compared to the prior year. Overall denials increased by nearly $250 million between 2019 and 2023. Additionally, in 2022, California’s Department of Managed Health Care overturned 55.9% of Independent Medical Reviews involving Blue Shield — a figure that raises serious questions about the insurer’s decision-making process.
Blue Shield has maintained that its “medical reviews follow clinical guidelines and are not based on cost.” In a statement about the upcoming hearing, the company said it reviews all escalations thoroughly and works “directly with appropriate parties when concerns are raised.” However, it declined to specify what process changes, if any, it has made.
Firefighters Demand Accountability
In January, Sam Gebler, president of the firefighters union Local 798, led dozens of first responders to the steps of City Hall in protest. They described a pattern of unreasonable insurance denials targeting cancer treatment for current firefighters, retirees, and their families — all covered under the city-backed Blue Shield program.
“We don’t walk away when things get hard,” Gebler said. “Neither should insurance companies that promise to fix the problem and profit from our service. Firefighters won’t let this go.”
Notably, San Francisco firefighters face elevated cancer risks due to repeated exposure to toxic substances on the job. This makes reliable access to cancer treatment especially critical for their community.
What Comes Next for Reform
Blue Shield Vice President of Government Relations Andrew Kiefer is expected to testify at the hearing. Representatives from Local 798 and the nonprofit watchdog Protect our Benefits will also appear.
A Call for Systemic Change
Supervisor Chan views this hearing as only the beginning. She intends to explore every possible avenue to hold city-contracted health insurers accountable.
“We will be examining every single possibility to make sure Blue Shield and any health care service provider that contracts with the city renders care that is important and critical,” she said. “The future of our health care is at stake. Clearly, we need reform.”
Meanwhile, Assemblymember Catherine Stefani has already met with Blue Shield executives to discuss the Jones case — a sign that scrutiny is escalating beyond City Hall. Consequently, pressure on Blue Shield is growing from both local and state-level officials.
For Jones and thousands of city employees like him, the stakes could not be higher. When insurance denials block life-saving treatment, the consequences go far beyond paperwork.
