PITTSBURGH (KDKA) – A local university claims its insurance company violated some deeply held beliefs when it reimbursed certain drug expenses.
Duquesne University is accusing Highmark of paying for contraceptives that the university never would have agreed to pay.
Duquesne has sued Highmark, alleging the region’s number one insurance company violated a contract agreement with the Catholic university.
In a 140-page complaint, the university, which self insures 1,600 employees, said Highmark was hired to handle health insurance claims and was supposed to direct drug reimbursements to Caremark PSCHealth.
“Caremark is a prescription benefit manager [PBM],” Jim McTiernan of Triad USA said.
Triad USA advises companies on health insurance.
“Highmark as a general rule uses MedCo as their PBM. In this case, Duquesne opted to use Caremark, which is not a Highmark company, a Highmark affiliated company,” McTiernan said.
Duquesne accuses Highmark of processing claims through its own subsidiary, costing the school an extra $1.75 million. The university also claims Highmark reimbursed for drugs like contraceptives and Botox which are not allowed under the contract.
As a Catholic institution, Duquesne will not cover abortions, contraceptives, IUD’s, tubal ligations, or vasectomies.
“Common procedures, but that would not be in accordance with the Catholic faith, and that would be very understandable,” McTiernan said.
McTiernan said employees often think everything is covered under health policies.
“You are insured for the benefits that are purchased, and if you are insured by your employer, it’s the benefits that are purchased by your employer, and they dictate what benefits in fact are purchased,” McTiernan said.
Highmark said Duquesne went way beyond what was allowed.
Highmark has 20 days to respond to the lawsuit.