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Anthem Mental Health Coverage Class Action Lawsuit Overview:
- Where: The class action lawsuit was filed in New York federal court.
- Who: Insurance company Anthem and its subsidiary Anthem UM must face a class action lawsuit filed by three policyholders.
- Why: The plaintiffs allege that Anthem’s coverage guidelines are too restrictive, resulting in unfairly denied claims under laws governing employee benefits plans.
A New York federal judge denied Anthem’s request to dismiss a class action lawsuit that accuses the insurance company and a subsidiary of denying policyholders mental health treatment coverage.
Judge Frederic Block ruled that the plaintiffs in the class action lawsuit, policyholders Marissa Collins, James Burnett, and Karyn Sanchez, sufficiently argued that Anthem’s actions fall under the Employee Retirement Income Security Act (ERISA). Also accused of denying benefits is Anthem subsidiary Anthem UM, which makes the final determination in claims.
In its attempt to dismiss the class action lawsuit, Anthem argued that its guidelines were adopted as a business decision and not a “fiduciary act,” which would require them to act in customers’ best interests and fall under ERISA. However, Judge Block disagreed with this, ruling that the policyholders alleged that Anthem was acting in a fiduciary capacity since it established a benefit plan which requires the administrator to ensure that the plan is maintained.
Anthem’s Coverage Criteria ‘Impermissibly Restrictive,’ Complaint Says
The complaint, first filed in 2020, argues that Anthem’s internal coverage guidelines regarding residential mental health treatment are “impermissibly restrictive” under ERISA. ERISA requires employee benefit plans to cover mental health treatment similarly to medical treatment.
The policyholders say that Anthem’s guidelines criteria are “inconsistent with “medical necessity” as defined in (Anthem’s own) plans.” This structure supposedly encouraged Anthem employees to pay more attention to acute symptoms, although chronic symptoms are often better indicators for residential treatment, the complaint argues.
Thanks to this limiting structure, Anthem regularly and unreasonably denied policyholders coverage, forcing them towards more expensive medical bills or forgoing treatment altogether, according to the complaint.
Do you feel your coverage claims made to Anthem have been unreasonably denied? You might be eligible for compensation!
The plaintiffs are represented by D. Brian Hufford, Caroline E. Reynolds, Devon W. Galloway, Samantha M. Gerencir, and Jason S. Cowart of Zuckerman Spaeder LLP, and by Meiram Bendat of Psych Appeal Inc.
The Anthem ERISA Coverage Class Action Lawsuit is Collins v. Anthem Inc., Case No. 1:20-cv-001969, in the US District Court for the Eastern District of New York.
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