It’s been a busy start to 2025 for your POB directors, and the year is barely a month and a half old! Our new San Francisco mayor, Daniel Lurie, was sworn in on a very promising agenda to clean up our city. We want to welcome the new mayor and let him know we are looking forward to working with him. 

2025 also marked the start of the new Blue Shield CA (BSC) health care plan, and it’s been anything but “seamless.” We’ve already heard from many of you about a range of problems with the new plan – from pharmacy co-pays tripling to the much more serious and potentially life-threatening denial of services for surgeries and even ongoing cancer treatment. Luckily we were able to step in and resolve the more serious issues, but many problems persist. While we are your watchdogs, it is NOT our job to fix every transgression that we find. 

A few things to consider: 

  • After sending two letters of protest, POB members testified at the HSS board meeting last week, on Feb. 13, to the commission that was very surprised to learn about some of our issues. Thank you to all of you who were able to attend – in person or via zoom. 
  • It’s a numbers game – we’ve learned that BSC along with other subcontracted health providers have been using AI (artificial intelligence) the past few years to deny up to 90% of all claims – often denying claims in a matter of seconds. There are several lawsuits in the works around this very issue. Most people don’t know to challenge the denials, and end of paying out of pocket. But we discovered those who do challenge the denials win their appeal 80% of the time. You can read more about the appeals process below. 
  • We discovered the contract between BSC and the Health Service System (HSS) system has not yet been signed or finalized 
  • We are categorizing all of your complaints and presenting them to HSS. 
  • We continue to work closely with BSC and HSS to resolve these problems, but we must insist that our San Francisco city and county retirees deserve better and get what they were promised. 

Read below for some details and suggestions if you encounter issues.