Anthem has reached a settlement of $12.875 million in a class action lawsuit concerning the denial of claims for residential treatment related to mental health conditions and substance use disorders. Customers who had their claims denied between April 29, 2017, and April 30, 2025 may be eligible for compensation. This settlement provides a potential financial benefit to those affected.
The lawsuit claimed that Anthem had rejected requests for coverage of residential treatment services by asserting that the care was not medically necessary. Plaintiffs argued that Anthem employed criteria that were more stringent than generally accepted standards of care. Although Anthem denies these allegations, the company has opted to settle to mitigate the costs and uncertainties associated with prolonged litigation.
Individuals who paid out-of-pocket for residential treatment services after having their coverage requests denied within the specified timeframe can submit claims to become Class Members. To qualify for compensation, claims must be submitted by January 20, 2025. The total amount each Class Member receives will depend on the number of claims submitted. All qualifying members will receive either a pro rata share from the Out-of-Pocket Reimbursement Fund or a minimum payment of $100.00, as outlined in the notice provided by Anthem.
A Fairness Hearing is scheduled for January 26, 2025, to evaluate whether the proposed settlement is “fair, reasonable, and adequate.” This hearing will allow affected parties to voice any concerns regarding the settlement terms.
For those who believe they are eligible, it is crucial to gather the necessary documentation to support claims and ensure submission by the deadline. This settlement serves as an important opportunity for individuals who felt the impact of Anthem’s coverage decisions during the specified period.
