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 and substance use disorders. This decision opens the door for eligible customers to potentially receive compensation, pending their submission of relevant documentation.
The lawsuit arose from allegations that Anthem denied requests for coverage for residential treatment services, asserting that the care was not medically necessary. Plaintiffs claimed that Anthem utilized criteria that were more restrictive than generally accepted standards of care. Although Anthem denies these allegations, the company has opted for a settlement to circumvent the costs and unpredictability associated with litigation.
Members who had claims denied by Anthem between April 29, 2017, and April 30, 2025, can claim their share of the settlement. To be eligible, individuals must submit their claims by January 20. The total amount received by each claimant will vary depending on how many individuals submit claims. All Class Members are assured either a pro rata share of the Out-of-Pocket Reimbursement Fund or a nominal payment of at least $100.00, according to the information provided by Anthem.
Understanding the Claims Process
To begin the claims process, individuals must gather documentation demonstrating their out-of-pocket expenses for residential treatment services denied by Anthem. This evidence is essential for validating claims and ensuring that eligible members receive their rightful compensation.
A Fairness Hearing is scheduled for January 26, during which a judge will assess whether the settlement is “fair, reasonable, and adequate.” The outcome of this hearing will have implications for the distribution of funds to Class Members.
This settlement presents an opportunity for those affected individuals to bolster their financial well-being in light of denied claims for necessary treatment. As the deadline approaches, it is crucial for eligible members to take action promptly to secure their potential share of the settlement.
