Anthem Blue Cross to Pay Members Who Suffered Eating Disorders $400K in Class Action Settlement

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 Anthem Blue Cross Class Action Settlement Overview:

• Who: Anthem Blue Cross has reached a $400,000 settlement with members who filed claims for eating disorder treatment
• What: The members allege that Anthem violated ERISA and state laws in its processing and denial of claims.
• Where: The settlement is for California-based consumers

Members of Anthem Blue Cross’s ERISA health plan who suffered from eating disorders and sued the company over alleged violations of ERISA in their coverage have reached a $400,000 settlement with the company.

As part of the settlement, members can either resubmit previously denied claims or receive a cash payment of $5,500 for those who continued treatment after claims were denied, or $2,100 for those who dropped treatment.

The settlement closes out a class action lawsuit that was filed by Aurora Bailey and Emily Jump in 2016. Bailey suffers from anorexia nervosa and major depressive disorder, both severe mental illnesses, and in May 2014 Bailey was admitted to a residential treatment facility for treatment of her eating disorder.

Anthem authorized the initial 20 days of treatment, but then denied authorization for further treatment, relying on its 2014 “medical necessity” guidelines for eating disorder residential treatment. Despite the denial, Bailey remained in treatment and paid over $75,000 for that treatment, the class action says.

Jump suffers from anorexia nervosa, major depressive disorder and obsessive compulsive disorder, and in March 2017 she was admitted to residential treatment for her eating disorder.

Anthem authorized 76 days of treatment, but then denied authorization for further treatment, relying on Anthem’s 2017 clinical guidelines for eating disorder residential treatment, according to the complaint. Jump remained in treatment and paid over $101,200 in medical bills.

The pair alleged Anthem’s denial of authorization for their continued residential treatment violated both ERISA and the federal and state parity laws, and they sought denied benefits and injunctive and declaratory relief.

The case was the fourth lawsuit brought against Anthem alleging that its “Utilization Review” program, a uniform set of policies and procedures used to review requests for mental health treatment, created unlawful barriers to treatment for those with one of the nine psychiatric disorders classified as severe mental illnesses under the California Mental Health Parity Act, the settlement reads. Therefore, the claims alleged, Anthem violated the Parity Act and other laws.

In addition to the payments, Anthem has discontinued using its internally created guidelines and criteria to evaluate the medical necessity of eating disorder treatment; has discontinued using doctors from a third-party vendor; has changed its non-certification letters so that the letters identify the peer reviewer in cases; and in denying a request for eating disorder treatment, the Anthem peer reviewer will identify the lower level of care that may be available.

The settlement sets a $400,000 “cap” on reprocessing claims, and says that if the amount of approved claims exceeds the cap, claimants will receive a pro rata share of the $400,000.

Notice forms must be sent to class members, with the deadline for class members to return claims forms being set for Dec. 27, 2021. The approval hearing is set for May 6, 2022.

​​In April, health insurance provider Humana was also hit with an ERISA class action lawsuit, alleging that it was charging its employees excessive fees for their retirement funds and mismanaging more than one billion dollars in assets, claims a new class action lawsuit. The nationwide class action alleged that Humana, its board, and other staff breached fiduciary duties by mismanaging the group’s retirement funds and charging “unreasonable” fees.

Have you ever been denied care from your insurance provider? Tell us about your experience in the comments section below!

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