Duquesne University sues Highmark
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Duquesne University on Tuesday filed a lawsuit against Highmark Inc., claiming that the insurer improperly paid reimbursements for birth control and other medications and procedures that go against the school's Catholic mission.
Filed in the Allegheny County Court of Common Pleas, the lawsuit seeks damages of $1.75 million.
A spokesman from Highmark did not return messages seeking comment.
"We've been trying to resolve this with Highmark for two years and were unable to reach a satisfactory conclusion," said Bridget Fare, a spokeswoman for the university.
According to the complaint, Duquesne contracted with Highmark in April 2004 to help the university administer its medical benefits program.
Under the contract, Duquesne specified that certain medications and procedures would be excluded from coverage to "conform with its Catholic mission." Those included contraceptive drugs and related procedures.
However, the complaint states that Highmark paid claims for drugs like Botox -- a drug used for cosmetic purposes -- Depo-Provera, a birth control injection, and for intrauterine devices for birth control.
The total paid for such claims from July 2007 through July 2010 was $1,524,900, the lawsuit said. In addition, Duquesne alleges that Highmark violated the contract by administering the university's prescription plan improperly.
According to the lawsuit, Duquesne uses CaremarkPSC Health LLC to manage its prescription drug benefits. That plan requires a $50 copay for certain specialty drugs, and Duquesne receives a financial benefit.
However, the lawsuit accuses Highmark of using its own prescription benefits provider, Medmark, to process claims, thereby denying Duquesne its benefits from CaremarkPSC. On that issue, Duquesne alleges that Highmark improperly processed $234,179 in prescription claims.
First Published August 3, 2011 12:00 am