MEMORANDUM

Memo To:   All Buffalo Teachers

From:         Philip Rumore, President, BTF

Date:          February 7, 2023 

Subject:    Highmark BC/BS Problem

As many of you are aware, there have been recent issues with BPS’s third-party administrator, Highmark denying insurance coverage for services and medication that should have been covered. As a reminder, your benefits should remain identical under the terms of the collective bargaining agreement. Any changes to your insurance plan are a violation of the negotiated terms of the CBA. BTF has filed a grievance and it is our belief that BPS is working with Highmark to resolve these issues.

If a claim for coverage or medication that has been previously covered is or has been denied, reach out to the Highmark Customer Service number on the back of your health insurance card. If this does not resolve the issue, email This email address is being protected from spambots. You need JavaScript enabled to view it. and request that BPS escalate the issues to its Account Manager.

The CBA also provides language for insureds to appeal the denial of any claims or coverage. Article XXVI (2).A.(a)(iv) states, “[a]ny complaints under The Plan with respect to interpretation, application or payment of benefits must be processed through the ‘Claim Review Procedure’ set forth in The Plan. If a complaint is not settled to the teacher’s satisfaction, the teacher may submit the dispute directly to the current BC/BS dispute resolution process within ninety (90) days of the written determination.” (page 68, lines 34-43).

A copy of The Plan Document can be found here (Click Here) and the appeal procedure is described on page 42.

We are also seeking NYSUT’s assistance to file a class action lawsuit along with other organizations.