Fighting for Healthcare

Fighting for healthcare starts with breaking insurance monopolies.

In April, I called a hearing into the denial of healthcare by Blue Shield for our employees, retirees and their families. These denials came to light after a retired firefighter, Ken Jones, shared his story about being denied care as recommended by his oncologist for his Stage IV lung cancer. Firefighter Jones served and protected our City for almost 20 years, and to be denied treatment, particularly at this most critical time of care, is unacceptable. Across our country we are seeing access to healthcare being cut, made unaffordable or inaccessible. We must push back – we cannot allow insurance companies to put profit over people.

At the hearing, representatives from Blue Shield and our City Health Services System (HSS) presented and fielded questions into the denials, appeals processes and next steps. We also heard from Protect our Benefits, an advocacy group representing retirees and members of the public who shared heartbreaking stories about being denied or delayed care. We heard about a retired firefighter who was waiting for a double lung transplant. Although the transplant had been approved, surgery was delayed due to an administrative review of the mandatory training. These administrative delays and denials are hurting, and, in fact, killing people.

We know that this is not limited to Blue Shield. At the hearing, we learned that, according to San Francisco’s Health Service System, about 21% of claims are being denied by our city insurers. This, too, is unacceptable. So I have tasked HSS with auditing these denied claims, including reporting on the percentage of claims denied, timelines to resolve claim denials and appeal processes and a mandate for a direct hotline for San Francisco retirees and workers. I asked Blue Shield to meet with Protect our Benefits, create a direct channel to address appeals and provide a written memorandum of understanding by the beginning of May. In addition, I asked HSS to provide data on claim denials and timeline for resolution from all service providers before they come before the Budget Committee for another year of contract approvals.

We are reconvening this hearing later in May, to hear back from Blue Shield, HSS and Protect our Benefits on their progress. I am going to keep pushing this issue – we owe it to our workers, our families and our retirees, including those who have risked their lives to safeguard ours. We can and we should do better. We know that as goes San Francisco so goes the nation. We will make sure healthcare is equally accessible to everyone in San Francisco and nationwide.

Connie Chan represents District 1 on the San Francisco Board of Supervisors. She can be reached at 415-554-7410 or chanstaff@sfgov.org.