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Retired firefighter—s denied treatment draws scrutiny; SFHSS director cites Medicare rules, Blue Shield pledges review
Summary
Public comment and the SFHSS director's report focused on retired firefighter Ken Jones—s prior‑authorization denials by Blue Shield. Director Ray Guillen said Medicare/ CMS rules and an independent review upheld the denials; callers and unions urged further investigation and data collection.
Ray Guillen, executive director of the San Francisco Health Service System, addressed public concern over a retired firefighter—s denied prior authorization during his director—s report, telling the board that "at the heart of this matter is actually Medicare rules" and that an independent review entity, Maximus, upheld Blue Shield—s denial because some treatments were not FDA‑approved for the requested off‑label use.
Family members and firefighter advocates disputed that characterization during public comment. Helen Horvath, the caller who identified herself as the wife of Ken Jones, said the family had raised private funds for his initial immunotherapy and later received care under traditional Medicare; she called…
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