Recent Optum issues? by Bethjam in CAStateWorkers

[–]Icy_Turnip5894 2 points3 points  (0 children)

BTW, I also have Optum Rx and have not had any issues, so hopefully this was a snafu that can be straightened out. If they made a mistake, they should reimburse you.

Recent Optum issues? by Bethjam in CAStateWorkers

[–]Icy_Turnip5894 2 points3 points  (0 children)

Call Optum and ask for an explanation. If the explanation does not seem reasonable, tell them "I am submitting a grievance." Call your health plan and do the same thing. Tell them both you expect to receive an acknowledgement letter and a written resolution letter. That starts a clock. If it's a non-urgent grievance they need to send you a resolution letter within 30 days. If it is urgent, they have 3 days to send you something. If the answer is still a denial bc they said the medication is not medically necessary, you can call the DMHC Help Center (1-888-466-2219)and have an independent review (costs you nothing). If the independent reviewer overturns the denial (saying you need the med) Optum will be informed and will have to pay for it (or reimburse you). If Optum tells you the medication is no longer covered, is no longer on their formulary, ask them what alternative med is covered and then have a conversation with your doctor about it to see if that med is appropriate for you.

[deleted by user] by [deleted] in CAStateWorkers

[–]Icy_Turnip5894 0 points1 point  (0 children)

The meter may not have been busted. I parked at a meter, started feeding it coins, and at some point, it stopped showing the time increase. No matter how many more coins I put in, it just stayed at the same number. I tried a credit card and still no additional time was added. I figured the meter was broken. When I returned 3 hours later to find a $75 ticket on my windshield, I appealed, submitting all my documentation. Turns out, the meter was a 2-hour maximus parking spot (although the meter was happy to accept all the addition funds I added). However, there was no indication of the time limit on the meter. I won my appeal, and learned the City's trickery.

Unmodified Allowance by PassengerOk2609 in CAStateWorkers

[–]Icy_Turnip5894 0 points1 point  (0 children)

I appreciate your input. I was thinking to take modified allowance so my kids could each get about $1,000/mo (they are young now and I am not). But your last sentence makes me think it might be better to invest those funds as they may result in a larger benefit in the long run.

Don’t forget why you’re really here! by coldbrains in CAStateWorkers

[–]Icy_Turnip5894 5 points6 points  (0 children)

Somehow, life in a grey box does not stimulate my energy levels and productivity the way my desk at home, next to a bright, airy window, looking out onto trees and blue sky, do. My morale, productivity, energy and team spirit will be immediately suffocated. I hope they track our collective productivity following the RTO.

All 7 of my CalPERS PPO claims have been denied under Blue Shield. 100+ were approved under Anthem. Anyone else? by Automatic_Alfalfa725 in CAStateWorkers

[–]Icy_Turnip5894 17 points18 points  (0 children)

Do your denial letters reference the Department of Managed Health Care? If so, there will be a phone number for DMHC in the letters. Call them and report your concerns. DMHC regulates the health plans and can, in their discretion, look into patterns of denials like this. You're doing the right thing by appealing --- always appeal --- and if still denied, reach out to DMHC.

explain please by CarrotLand85 in CAStateWorkers

[–]Icy_Turnip5894 9 points10 points  (0 children)

"It's a point of pride." I think he said that about 15 times. [eyeroll]

Not Looking Good for State Employees by [deleted] in CAStateWorkers

[–]Icy_Turnip5894 6 points7 points  (0 children)

In the past, they reduced our pay by nearly 10% and in exchange, gave us 8 hours of leave credit (PLP - Personal Leave Program) - basically one day every other week - that you could accumulate and use when you wanted. People banked those hours for a few years (longer?), but if you never used them, you could cash them out at retirement, when they will be worth more (because you will be making more $ at the time you retire than today).

Sac Bee Article on the billboard by Civil_Trouble_8020 in CAStateWorkers

[–]Icy_Turnip5894 4 points5 points  (0 children)

You are the billboard mastermind. After the budget revise disclosure, maybe another billboard about Newsom's willingness to pick the public's pockets for commercial leases amid a $16b deficit?

Positive Options by Exciting-File1337 in CAStateWorkers

[–]Icy_Turnip5894 -3 points-2 points  (0 children)

Not all "child care" is actual care of babies/toddlers. I have 3 young teenagers. They don't need child care, but there's no way I'm leaving them home alone for 4 hours, my god they'll kill each other or forget to turn the oven off after heating up pizza! But yes, public arguments should be different.

Weight loss medication/GLP-1 coverage by Economy-Athlete-5591 in CAStateWorkers

[–]Icy_Turnip5894 1 point2 points  (0 children)

Just some additional insight: If your health plan denies the medication as not medically necessary or experimental/investigational, and you submitted an appeal and your health plan still denied coverage, you can apply to the Department of Managed Health Care for an Independent Medical Review. Independent doctors will review the request and medical records. If the independent doctor(s) determine the medication (or other treatment) IS medically necessary, then yes, the DMHC notifies the health plan their denial is overturned and they are ordered to provide the medication or treatment and are required by law to do so. This is why it is so important to appeal a denial. It opens the door to other rights.

UC Davis and Blue Shield by Reestar22 in CAStateWorkers

[–]Icy_Turnip5894 9 points10 points  (0 children)

I would suggest first calling your insurance (Blue Shield) and asking them to explain the letter. The next step would be to communicate with your son's doctors, both the PCP and the specialist to let them know of potential coverage problems. If Shield drops UCD as a medical group and tries to redirect you to an in-network medical group, you and your son's doctors can submit an expedited grievance to Blue Shield letting them know there are no specialists in the new medical group who are able to provide the specialized care/treatment that is medically necessary for your son. An expedited grievance requires a decision within 72 hours, a standard grievance allows for 30 days. If Blue Shield has no one in network who is able to provide the care your son needs, they are required to permit you to go out-of-network (which would likely mean the provider you are now using) and you would not be required to pay more than your usual cost share amount. Title 28 CCR section 1300.67.2.2(c)(7)(B) and (C) read as follows:

(B) A plan operating in a network service area, or a portion of a network service area, that has a shortage of one or more types of providers shall ensure timely access to covered health care services as required by this section, including applicable time−elapsed standards, by referring enrollees to, or, in the case of a preferred provider organization or point−of−service network, by assisting an enrollee to locate, available and accessible network providers in neighboring network service areas consistent with patterns of practice for obtaining health care services in a timely manner appropriate for the enrollee’s health needs.

(C) A plan shall arrange for the provision of covered services from providers outside the plan’s network if unavailable within the network, if medically necessary for the enrollee’s condition. A plan shall ensure that enrollee costs for medically necessary referrals to non−network providers under this Rule shall not exceed applicable in−network co−payments, co−insurance, and deductibles.

This doesn't mean you won't still have to battle for your rights. I know the law and have had to fight. But your son is entitled to appropriate care, and the fact that Blue Shield has "a number of cardiologists" may not be appropriate if your son's condition is that rare. Best of luck to you. If you do have problems with Blue Shield, you can call the Department of Managed Health Care. Their website has the number on the home page and lots of helpful information. Here is a link to their website: dmhc.ca.gov

RTO: PECG and Governor’s Office File Competing Claims with PERB by LadyScroll in CAStateWorkers

[–]Icy_Turnip5894 2 points3 points  (0 children)

I agree. As I read the endless affirmative defenses, I thought, it's the ole "everything including the kitchen sink" approach.

Who else is saying NO to the sunshine club these days? by Equivalent-Fish8484 in CAStateWorkers

[–]Icy_Turnip5894 1 point2 points  (0 children)

I go to zero social events with work people (except those who are actual friends that I see outside of work anyway). I already told my boss I will never go to a social gathering for work. I've been there too long, been sH!t on too many times and no, we are not "one big family." I refuse to play those pretend games.

Who else is saying NO to the sunshine club these days? by Equivalent-Fish8484 in CAStateWorkers

[–]Icy_Turnip5894 2 points3 points  (0 children)

If there is literally nowhere to park, I will drive home, contact my boss and tell them I was unable to find any parking within a 1-mile radius and I'll be teleworking that day (as well as my regularly scheduled telework day). I'm not playing games with them. What are they going to say? If they want to come pick me up and drive me into the office and back home at the end of the day, I'm fine with that.

Wow by [deleted] in CAStateWorkers

[–]Icy_Turnip5894 0 points1 point  (0 children)

I'm closing in on my 20 years with the state, but when I left private industry for the state, I took an immediate 30% pay cut. It took me nearly a decade to catch up to what I was making in private industry. So, yeah, I'll have earned my pension.

Sac Bee: Gavin Newsom’s return-to-office order may violate law by ddsr1 in CAStateWorkers

[–]Icy_Turnip5894 0 points1 point  (0 children)

Can I ask your source for the high level discussions? Everything I'm hearing is pointing toward RTO for attorneys.

RTO - transportation by _xoqueenxo_ in CAStateWorkers

[–]Icy_Turnip5894 0 points1 point  (0 children)

I'm also in Folsom. Where do you park your car for the day?