‘They should be ashamed’: San Francisco firefighter dies after years-long fight with insurance over cancer care delays and denials

Firefighters face elevated cancer risks compared with the general population, with research from the CDC’s National Institute for Occupational Safety and Health (NIOSH) showing a roughly 9% higher incidence rate.

The risks are tied to repeated exposure to smoke, toxic particles, and hazardous materials on the job — making timely access to treatment especially critical for the profession.

In Jones’ case, that urgency collided with a years-long dispute over coverage. He and his physicians were openly critical of his city-sponsored insurance provider, Blue Shield of California, after it twice denied part of the cancer treatment his oncologist recommended.

“I believe, wholeheartedly, that they expedited his death,” Jeanine Nicholson, the former chief of the San Francisco Fire Department and a close friend of Jones for roughly 30 years, told NBC Bay Area. “They should be ashamed.”

Long career as a firefighter

Jones spent 17 years with the fire department, later stepping into a role as a lead counselor, where he helped fellow first responders work through trauma, serious illness, and the strain that comes with the job.

After NBC Bay Area’s series of investigative reports on his battle with Blue Shield, San Francisco supervisors called senior insurance executives to City Hall to answer questions. Lawmakers called for changes aimed at speeding up care approvals for first responders and working with the firefighters union in hopes of preventing similar delays.

Blue Shield is one of three insurers San Francisco uses to cover city workers and retirees — a system that costs more than $1 billion and serves over 40,000 people, according to figures obtained by NBC Bay Area from the San Francisco Health Service System.

But critics say that doesn’t always translate into smooth access to care. Instead, patients can still end up trapped in paperwork, approvals, and delays at the exact moment they can least afford it.

In response to NBC Bay Area’s investigation, Blue Shield said the issue wasn’t cost. The insurer said it based its decisions on medical guidelines that, in its view, did not support the specific combination of chemotherapy and immunotherapy Jones’ oncologist was seeking.

Jones’ doctor, Dr. Matthew Gubens, disagreed. “There’s [a] gray area in medicine,” he previously told NBC Bay Area. “The time spent trying to get approval of a regimen that I requested, [Ken] lost ground — tumors are growing, pain is increasing, his appetite is going down.”

Moneywise reached out to Blue Shield for comment, and received the following statement: “We are deeply saddened to learn of Ken Jones’ passing and extend our heartfelt condolences to his wife, family, friends and former colleagues in the San Francisco Fire Department. Due to federal and state privacy laws, we cannot provide further comment.”

After the initial denial, Gubens also described a frustrating appeals process, saying he spent hours on the phone and kept getting transferred between departments without ever reaching the right place to file the request.

“I reached people who apologized, but they weren’t the right place to send the appeal to and often referred me back to the first person I talked to,” he said. “That day, I spent about three hours calling different phone numbers for this insurance company.”

The hidden cost of delays and denials

Even with insurance, getting cancer treatment approved can turn into a battle of delays and denials. For some patients, it drags on while time slips away.

On paper, it’s “administrative” or “procedural.” In reality, however, it can mean treatments getting pushed back, care plans thrown off track, and patients left carrying additional stress and uncertainty.

In Jones’ case, the coverage dispute became a second battle running alongside his illness — one marked by repeated appeals and back-and-forth conversations between providers.

Blue Shield and other insurers say these decisions are driven by medical guidelines and clinical evidence, not cost. Critics, however, say the gap between how those guidelines are applied and what doctors actually recommend can leave patients stuck in limbo.