Anthem Mental Health Treatment Settlement: $12.88M

Individuals covered by a health benefit plan governed by ERISA whose requests for residential treatment services for a behavioral health disorder were denied by Anthem on or after April 29, 2017, based on Anthem’s Clinical UM Guidelines or the MCG Guidelines for Residential Behavioral Health Level of Care.

Denials must not have been reversed on administrative appeal.

Proof of payment for a residential treatment episode that began no later than 14 days after a qualifying denial. Reimbursement is limited to 365 days per treatment episode.

Anthem, now operating as Elevance Health, agreed to a $12.875 million class action settlement resolving allegations that it improperly denied coverage for residential behavioral health and substance use disorder treatment.

According to the class action lawsuit, Anthem applied overly restrictive medical necessity criteria that were inconsistent with generally accepted standards of care. Plaintiffs argue that these guidelines violated both the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act by unfairly limiting access to covered behavioral health care.

While Anthem denies any wrongdoing, the insurer opted to settle the claims rather than continue with litigation.

Class members can receive reimbursement from the settlement if they paid out of pocket for residential treatment that began within 14 days of a denied claim. Payments will be distributed on a pro rata basis, based on the number of claims and the length of each treatment episode, with a maximum of 365 days eligible for reimbursement.

If a claimant does not receive a share of the reimbursement fund, they will receive a nominal payment of at least $100.

To be eligible for a payment, claim forms must be submitted by January 20, 2026. The deadline for objections or exclusion is December 19, 2025, and the final approval hearing is set for January 26, 2026.