By John Q. Hosedrinker 
A retired San Francisco firefighter diagnosed with stage 4 lung cancer is seeking city intervention after his insurance provider, Blue Shield, denied his treatment. His colleagues and family members pleaded with the City and County of San Francisco’s Health Service Board, which approved Blue Shield’s insurance plan, to get involved. They are concerned that Blue Shield is prioritizing profits over the lives of those who spent their careers protecting the city, and Supervisor Matt Dorsey pledged to question Blue Shield regarding this matter. Blue Shield took over from UnitedHealthcare a year ago, and other firefighters are reporting problems with their coverage, leading to concerns for future firefighters.
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City asked to intervene after SF firefighter’s stage 4 lung cancer treatment denied by Blue Shield, a situation that immediately sparks outrage. If we’re not providing care for firefighters with lung cancer, what exactly are we doing here? It’s a stark reminder of how broken our healthcare system has become, especially when a health insurance CEO can presumably sleep soundly after denying life-saving treatment. The very concept is appalling.
It’s disheartening to see insurance companies, often operating as what feels like “death panels,” making decisions with virtually no recourse for the individual. The situation highlights the desperate need for change. Perhaps a move towards a Medicare-for-all model, while allowing for employer-sponsored enhancements, might be a step in the right direction. It’s time to realize that not everything needs to be driven by profit, especially essentials like healthcare.
One can’t help but notice the irony in all the rhetoric about supporting first responders, only to have them face this kind of battle when they need healthcare. Some people might even suggest the city should consider suspending emergency services for Blue Shield properties – a drastic measure that speaks to the level of frustration. It underscores a larger problem: for-profit healthcare, particularly when it comes to non-profit entities paying their CEOs exorbitant salaries.
The denial of care could have resulted from the Center for Medicare Services (CMS) requirements for certain treatments, though it seems this case involves a Medicare advantage plan. Firefighters are often presumed to have contracted lung cancer due to their profession, making it a potential workers’ compensation claim. The fact that the diagnosis was initially deemed “not service related” echoes the experiences of many veterans dealing with the VA, a frustrating parallel.
Given that California Labor Code 3212.1 presumes that cancer results from firefighting exposure, the firefighter should undoubtedly contact a workers’ compensation attorney. Moreover, the state’s Senate Bill 1127 (2022) strengthened protections, extending the filing time and shortening the denial period. It’s hard not to wonder why the firefighter might not have filed, considering the existing protections.
There are questions to ask about the denial and its potential underlying reasons. We can’t avoid asking why treatments are denied or why a firefighter exposed to constant smoke and toxins would be denied healthcare. The system is designed to deny treatment to suffering cancer patients, enabling the c-suite to make money.
The fact that Blue Shield took over from UnitedHealthcare just a year ago seems particularly suspicious, raising questions about continuity and the prioritization of care. The unfortunate truth is that private health insurance needs to be re-examined. The excessive wages of executives and the profit-driven model are contributing factors to this crisis. The CEO of Blue Shield of California is Mike Stuart, and the public deserves answers.
This is not a unique situation. It’s the norm. The fact that an organization denies a firefighter the treatment he needs is beyond unacceptable. Healthcare is a nightmare, and until you or a loved one faces a life-altering illness, many can’t comprehend the stress and burden it places on individuals and families. The financial, emotional, and physical strain is immense.
High premiums, high deductibles, and the constant battle to get treatments and medications covered is exhausting. Insurance companies have endless ways of turning down procedures or denying medications. It often falls on the patient or family to navigate the complex system, acting as their own advocate, to the exhaustion of everyone involved.
The reality is that America is an outlier. We are the only industrial nation in the world that does not provide some form of universal healthcare. We have some of the highest infant mortality rates and healthcare costs, yet our politicians do nothing, especially when lobbyist checks are involved. The cost of healthcare and home insurance are pushing families to the brink.