Retired SF Firefighter Cancels Blue Shield After Immunotherapy Denial; Lawmakers Press Insurer

Ken Jones, a retired San Francisco firefighter who served 17 years and is battling stage 4 lung cancer, discontinued his Medicare Advantage coverage with Blue Shield of California in mid-February and enrolled in traditional Medicare in hopes federally administered Medicare will cover an immunotherapy his UCSF oncologist recommended. Family members say the denial came as Jones was preparing to begin a round of chemotherapy.

Jones’ family says Blue Shield refused to pay for the immunotherapy on Jan. 7, and Dr. Matthew Gubens, a veteran oncologist at UCSF, filed a written appeal after preparing a new treatment plan. Jones’ daughter, Rachel, told city officials at a Health Service Board meeting: “Blue Shield has decided that my father's life is not worth paying for.” Helen Horvath, Jones’ wife, said clinicians were “shocked” by the denial and warned that “time is of the essence” as a tumor grew from what the family described as pea-sized to egg-sized.

After the family publicized the dispute, Blue Shield approved a different chemotherapy medication the family had not requested but did not approve the immunotherapy that Dr. Gubens recommended. Horvath summarized the outcome: “[It] covers a different chemotherapy medication and doesn’t include immunotherapy, which was recommended by Jones’ doctor.” She added: “After we got some publicity, thank you, a Blue Shield physician reached out to Ken's physician, and they worked out a different plan that Blue Shield would cover. It's still an incomplete plan.” Blue Shield has said that “for Medicare members, health plans must follow medical policy established by the Centers for Medicare and Medicaid Services (CMS).”

City Hall became a focal point after current and retired firefighters and advocates rallied on the steps, pressing Blue Shield and calling for oversight. Mayor Daniel Lurie told the crowd: “You all always have our back, and we're always going to have your back, especially when it comes to your health care. We will get to the bottom of this.” San Francisco Fire Department Chief Dean Crispen said officials have “heard of three other retired firefighters that are being denied cancer treatment by Blue Shield.”

Advocates and firefighter health groups say the case may be part of a broader pattern. Adam Wood, vice president of the San Francisco Firefighters Cancer Prevention Foundation, said the foundation is reaching out to partners to identify other retirees who may have been denied care and noted that one retired firefighter died in December 2025 after a two-month delay in treatment. Tony Stefani with the foundation told supporters that “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,” and that firefighters with a cancer diagnosis have a 14% higher chance of dying than other cancer patients in the general population.

The dispute has also prompted scrutiny of the city’s insurer contracts after a change last year moved some public workers and retirees from UnitedHealthcare to Blue Shield, affecting roughly 5,000 employees and retirees. A city official who reviewed the switch said city leaders are “starting to regret that decision.” Protect Our Benefits president Fred Sanchez said, “This is not the first time a San Francisco firefighter has struggled to get cancer treatment approved.”

Officials and advocates say they will continue to gather cases and press for answers as Jones waits to see whether traditional Medicare will cover the immunotherapy his physician recommended and as the Health Service Board and city leaders review insurer decisions affecting thousands of public workers and retirees.