The controversial insurance denial involving a veteran firefighter’s cancer treatment has drawn the ire of California Assemblymember Catherine Stefani, D-San Francisco, who has summoned top leaders from Blue Shield of California to meet with her and firefighter advocates on Monday to explain the rationale behind the private insurer’s recent actions.

“I think it’s just reprehensible,” Stefani told the NBC Bay Area Investigative Unit. “This firefighter is fighting for his life — he shouldn’t have to fight his insurance company to get the care he needs to prolong his life.”

Stefani said she was angered, frustrated, and saddened to learn Ken Jones, 71, had part of his cancer treatment recently denied by Blue Shield.

Jones, who retired from the San Francisco fire dept. in 2012, was diagnosed with Stage 4 lung cancer last year. His physician believes the disease is likely linked to Jones’ 17 years working as a firefighter amid smoke and ash.

Blue Shield, which administered Jones’ Medicare Advantage Plan, said it denied the immunotherapy Jones’ oncologist requested because FDA and Medicare guidelines only allow the treatment when it is used early as a “first-line therapy.” Blue Shield deemed Jones ineligible since he previously underwent other rounds of cancer medication.

“Our hearts go out to individuals and their families who are facing a cancer diagnosis or navigating treatment,” a Blue Shield spokesperson previously wrote in a statement. “We are committed to supporting our members with compassion and working with their doctors to help them access care and resources.”

Jones’ oncologist. Dr. Matthew Gubens, views the immunotherapy he prescribed as a continuation of Jones’ initial treatment since it was never completed. Jones paused his chemo and immunotherapy in order to receive a pair of medical trials. However, when those experimental treatments didn’t deliver the results doctors had hoped, Gubens decided to get Jones back on immunotherapy, which Blue Shield denied.

After receiving Blue Shield’s denial letter, Gubens immediately called the number listed on the insurance document to lodge an appeal. After spending nearly three hours on the phone, however, he says he was never able to reach the appropriate person, so he submitted his appeal in writing, which Blue Shield ultimately denied.

“He couldn’t even get through,” Stefani said. “If he can’t, who can?”

Stefani said she will ask Blue Shield executives to explain how they plan to prevent future patients and physicians from encountering the same problem when trying to phone the company to appeal a denial.

“At the very least, what I want to come out of this meeting … is a promise from Blue Shield to create a [phone] line or to a live person when it involves claims for our firefighters up and down the state,” she said. “If they fight me on it, I’ll legislate it.”

Stefani says her meeting is expected to include the insurance company’s vice president of state govt. affairs Andrew Kiefer, chief medical officer Ravy Kavasary, and lobbyist Alex Tourk. Representatives from San Francisco’s local firefighters union are also expected to attend.

Blue Shield did not immediately respond to NBC Bay Area’s request for comment regarding Stefani’s upcoming meeting with company leaders, but the company has previously stood by its decision to deny Jones’ immunotherapy, saying it followed FDA and Medicare guidelines.

“They seem to forget there’s a human being involved here that’s very sick and that needs help,” Stefani said. “I just don’t understand why they can’t do better.”

Catch up on our series now

Part 1:

Ken Jones, who spent 17 years as a San Francisco firefighter, is asking government officials to intervene after his city-provided insurance plan declined to approve a new course of treatment Jones’s oncologists believe would help slow down the progression of his stage 4 cancer.

Part 2:

A retired San Francisco firefighter, who spent nearly two decades willingly putting his life on the line for others, now finds himself fighting for survival while in a battle against his own insurance company. Senior Investigative Reporter Bigad Shaban reports.

Part 3:

The head of San Francisco’s health oversight board determined Blue Shield acted appropriately in denying immunotherapy to a San Francisco firefighter suffering from Stage 4 cancer. Senior Investigative Reporter Bigad Shaban explains why some are angered by the decision and what they perceive as a lackluster investigation by a city official.

Part 4:

Longtime San Francisco firefighter Ken Jones believes he has found a way to receive the cancer treatment previously denied by Blue Shield under his Medicare Advantage plan. Senior Investigative Reporter Bigad Shaban explains.

Part 5:

Assemblymember Catherine Stefani (D-San Francisco) is scheduled to meet with Blue Shield of California executives and their lobbyist on Monday to discuss the high-profile insurance denial of longtime San Francisco firefighter Ken Jones. Senior Investigative Reporter Bigad Shaban explains.

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