Emily Sortor  |  December 27, 2019

Category: Insurance

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anthem health insuranceAnthem Health Plans of Kentucky Inc. will pay a $300,00 settlement to end claims that the insurance company wrongly denied benefits for autism-related conditions. 

The settlement received preliminary approval from U.S. District Judge Rebecca Grady Jennings last week.

However, Judge Jennings did say that the attorneys’ cut of the settlement was a bit high, set at 38 percent, and requested more information from policyholders’ attorneys about why they believed such a sum was fair and reasonable.

Of the $300,000, around $115,000 will go to lawyers for their fees, and the remainder will be divided up amongst Class Members — 46 people who had claims for benefits related to autism treatment and therapy denied by Anthem.

The policyholders said these denials violated the Employee Retirement Income Security Act and the Mental Health Parity and Addiction Equity Act. These laws prohibit insurance companies from denying mental health claims more frequently than physical health ones. 

Of those Class Members, 19 are people who billed for ABA therapy worth less than $250 but were denied payment for reasons of “Benefit Maximum Met” or “Units exceed a utilization management authorization.”

These Class Members will be eligible for $250 from the settlement fund, or a pro rata amount from the settlement fund, whichever is greater. All other Class Members will receive a flat amount of $250.

For her role in the Anthem autism claim denial class action lawsuit, lead plaintiff Margaret Wilson will receive an award of $10,000.

Any funds that remain from uncashed checks 120 days after payment is made will be given to the organization Families for the Effective Treatment of Autism. 

The Anthem autism benefits class action lawsuit went through some developments before the current settlement approval. In 2017, a Kentucky federal judge granted class certification to a smaller group of 26 Class Members.

Anthem attempted to fight the class certification, claiming that 26 was too small a class for certification. However, the policyholders then added more Class Members to their Anthem class action lawsuit.

Wilson filed her Anthem claim denial class action lawsuit in 2014, saying that Anthem wrongly refused to reimburse tens of thousands of dollars in claims for her child’s autism therapy treatment at the Highlands Center for Autism in Kentucky.

This is not the first time that policyholders have accused Anthem of wrongly denying claims for autism therapy benefits. In 2018, the company settled very similar claims with another class of policyholders in Indiana. Parents in the previous Anthem class action lawsuit claimed that that autism therapy that was denied for coverage by Anthem was medically necessary, and drastically improved their children’s well-being.

Do you believe that you were wrongly denied benefit claims for mental health services? Share your story with us in the comment section below.

The policyholders are represented by Robert R. Sparks of Strauss Troy Co. LPA.

The Anthem Autism Therapy Claim Denial Class Action Lawsuit is Wilson, et al. v. Anthem Health Plans of Kentucky Inc., Case No. 3:14-cv-743, in the U.S. District Court for the Western District of Kentucky.

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One thought on Anthem Settles Autism Therapy Claim Denial Class Action

  1. ROBERTA MAYFIELD says:

    PLEASE ADD ME

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