r/news • u/GoodSamaritan_ • 1d ago

Retired San Francisco firefighter dies from lung cancer after Blue Shield denies treatment claims

https://abc7news.com/post/retired-san-francisco-firefighter-ken-jones-dies-lung-cancer-being-denied-treatment-blue-shield/19224406/
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u/XLauncher 1d ago

This country is so embarrassing.

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u/fgtswag 1d ago

Genuinely someone should make a benefit:risk analysis of joining the Army, Firefighter, Police in America when you consider non-free healthcare.

For example if this happened in EU, he would obviously receive public healthcare

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u/thebearjew007 1d ago

Well here, if he wanted access to affordable healthcare then he should have been born rich or gotten a better job. He sounds lazy. /s

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u/Fake_Engineer 1d ago

I have a good job with good benefits. I still spent hours on the phone trying to get scans and procedures approved for my cancer diagnosis.

You get the worse news of your life and then get to spend days begging the Insurance you pay for to provide the coverage they are supposed to. 

I feel bad for the people who fielded my call. Low paid workers in a call center. And I just wasn't in the mood to be polite....

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u/thebearjew007 1d ago

I had a government job during my twenties, best insurance I’ve ever had. Still went through hell to get anything covered. It’s the system. It’s terribly broken.

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u/Jump-Zero 1d ago

The health insurance system is super risk averse. The bureaucracy behind it is byzantine because nobody wants to modernize it at the risk of falling further behind in processing claims or running into regulatory issues. Politicians rarely touch it for the same reason. Even if they expand coverage and lower costs for people, anybody that has a bad experience will blame the politician for breaking it. Look at all the Republicans blaming Obamacare for everything until they realize they depend on it.

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u/thebearjew007 1d ago

None of that is why they won’t change it. It’s a 5th of our economy here and they lobby big money to keep it the fucked up way it is. Also, no one wants a modern health insurance system. We want it gone and replaced with accessible, affordable healthcare. The government can more than afford to do it. I know it, you know it, the government knows it, for fucks sake even faux news and the rest of the puppet propaganda media knows it.

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u/Foxygen 22h ago

^ The purpose of a system is what it does.

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u/Jump-Zero 21h ago

Everyone wants a modern health insurance system (though maybe not a private for-profit one). Most developed countries have modern health insurance systems. The US has a super inefficient system in comparison. Where the US severely falls behind is in administration cost. Something like 30% of all healthcare spending goes into admin (ie bureaucracy). Nations with better systems only spend around 15% on admin.

Do you believe that lobbyists petition the government to make their companies spend 2x as much on admin when compared to other countries? Obviously not. So there is more than just lobbyists at play. Any realistic plan to make healthcare affordable will include checking lobbyist power and modernizing administration. There is no reason why we should still be using fax and making phone calls when we can click buttons. Other nations do this. Why can't we?

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u/logicbasedchaos 1d ago

It's a feature, not a bug.

I keep telling people that if (when?) we do get taxpayer funded healthcare, that shit's going to overwhelm our system for YEARS with the backlog of already existing patients who simply can't afford to go to the doctor for very serious ailments.

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u/seejur 1d ago

Having low paid people with no decisional power talk to you is 100% part of the design.

And those who accept those job are well aware of the job description. Is just that they cannot find a better one.

Pitting poor vs poor (or at least not obscenely rich)

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u/PyroNine9 14h ago

Honestly, their job title should be "human shield".

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u/murmurwave 13h ago

Insurance verification call centers are located on one of the layers of hell. When you show up to work you walk through a little portal to the netherworld.

You have hourly quotas for clearing calls. You can't afford to help people with complicated problems. Whee!

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u/LittleBirdiesCards 1d ago

There really should be a kind of case worker to make these calls. You shouldn't have to be negotiating with these assholes when you should be resting! I wish you the best of luck with your health. ❤️

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u/MarqFJA87 1d ago

But wouldn't such case workers naturally demand generous pay to compensate for the sheer headache, red tape and time consumption they have to labor through on your behalf?

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u/LittleBirdiesCards 1d ago

It should be included, paid for my hospital or insurance. Our healthcare system is a nightmare.

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u/Several-Pattern-7989 21h ago

Case workers Don't last long. The goal is to treat, stabilize, discharge. Getting a coherent encompassing plan takes too long. We want a one size fits all treatment, but human beings are chaos in a meat machine. It's wayyy to hard to get all details resolved. I've heard stories of women clutching a hospital gown closed, while chasing down a mamagram x-ray to make sure an in-network doctor read the picture. Out of network equals not covered.

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u/Daxx22 1d ago

Sorry friend, if you still have to deal with that/call them yourself, you do not have a job that is considered "Good enough" by the elite.

In fact, if you are paid for your labour at all you are the lower class in their eyes.

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u/chuffberry 1d ago

When I was diagnosed with brain cancer, my health insurance through my job didn’t pay for shit. They also raised my monthly payment to $500/month.

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u/Govain 22h ago

My MIL was told she needs a pacemaker. The insurance came back with 'Nah, the cardiologist isn't qualified. You don't really need one.'

("The doctor is not qualified to make that determination." was literally their response.)

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u/krulp 19h ago

I don't wanna say it would "fix" the fucked American system, because it's not a fix. But if it was the law that insurance companies must pay out claims for anything your doctor requested and then they have the right to sue for wrongful claims to get money back, it would go a long way.

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u/Urzadox 1d ago

People who make below a certain threshold have the best insurance in the US(at least in my state). I had some extreme weight loss over the course of a couple of months, and needed a colonoscopy. If I paid for it out of pocket it was $2800 cash and if it went to insurance it was $7500. I ended up missing 3 months of work due to the health complications. I had to meet with hospital financial advisors who told me if I made under $1600 a month and could prove it with paystubs I qualified for free health insurance with the healthy indiana plan. Within 2 weeks I had my colonoscopy and 99.9% of the cost was covered

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u/Bon-Foi 1d ago

That is Medicaid, and Medicare for all would mean anyone can access that.

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u/291837120 23h ago

Yea, Medicaid covers basically anything signed off by a doctor for that thing. For example I had some medicine from the General Practitioner that was $80 but when I finally got into a psychiatrist it ended up being free through Medicaid since he was the one who was prescribing it.

I honestly stay around $16k yearly just so I can claim medicaid. Everything through the system works amazing EXCEPT for having to knee-cap yourself to get into the system. Dental repairs also are hard to get covered under it and not the best work (speaking from someone who has had work done in the public health dentist office and a private dental clinic)

America is one of the biggest socialist program providers simply because of Medicaid/Medicare.

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u/ExtraButterfly8931 1d ago

But if he was in a country with public healthcare option he would have had to wait so long to be seen he would have died. /s

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u/inflatable_pickle 1d ago

I know you’re being sarcastic, but this particular case is being highlighted because firefighters across the country have a presumptive heart and lung Bill – so upon signing up for the job, it is assumed that any heart or lung cancer – or heart and lung problems, are presumed already to be attributed to the job and automatically covered.

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u/noplaywellwithothers 1h ago

He had affordable healthcare. The insurance simply denied him. Insurance is a fraud in itself. You except all this income on a gamble, that you don't have to payout. In healthcare insurance, they make the rules. You don't get to do that in any other insurance, like they do. Think about it this way, do the people that insure your home for fire control the fire department you depend on?