Blue Shield of California officials attended an April 8 hearing with the San Francisco Board of Supervisors regarding care denials for workers.
The hearing followed reporting from the NBC Bay Area investigative unit that featured a local firefighter who was denied cancer treatment.
Supervisor Connie Chan, who sponsored the hearing, said she learned from a response to an inquiry on Blue Shield’s denials that the carrier has a 21% in-network denial rate.
“The challenge around claim denials sounds like an administrative issue to me [rather] than an actual care issue,” she said. “They’re not doing a good enough job of processing claims — and actually adding administrative cost and challenges and bureaucracy into that process — and so therefore they cannot provide care in a timely fashion and an effective fashion.”
San Francisco Health Service System Executive Director Rey Guillen said Blue Shield’s prior authorization denial rates are “within industry norm,” and decision-making responsibilities rest with the carriers, not his team.
“Neither the Health Service System nor the Health Service Board is responsible for the specific denial decisions made by its health plan carriers,” he said. “Our role primarily is eligibility and enrollment.”
During the meeting, Blue Shield officials said they abide by evidence-based guidelines. Ms. Chan also relayed advocates’ requests for a meeting with Blue Shield.
“We deeply value our partnership with the city and county of San Francisco, and we want to ensure our members have access to the care and support they need,” Tim Lieb, senior vice president of commercial markets at Blue Shield of California, said in an April 10 statement shared with Becker’s. He participated in the hearing and said the organization has “taken concrete steps to better serve our members and partners,” including improved phone handling and support routing, a refreshed oncology review process, and more proactive physician-to-physician outreach.
“We recognize that the healthcare system has real challenges in delivering the experience patients deserve, especially when they are dealing with serious conditions,” Mr. Lieb continued. “We are focused on improving the parts of the experience that we can control, while continuing to advocate for policy changes to make our healthcare system work better for everyone.”
Blue Shield is one of three insurers that covers city and county employees in the area.
“Sometimes there’s a really competitive bid, and the good news is when you win it, you won it,” Supervisor Matt Dorsey, who also sponsored the hearing, said. “The bad news is you won it, and now everybody’s eyes are going to be on you, and there’s going to be a really high standard and high expectations to deliver.”
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