$12.88M Anthem mental health treatment class action settlement

Anthem agreed to pay $12.875 million to resolve claims it denied mental health and substance use disorder treatment claims based on overly restrictive medical necessity guidelines.

The Anthem settlement benefits individuals whose coverage requests for residential treatment services for a behavioral health disorder were denied by Anthem since April 29, 2017, based on Anthem’s Clinical UM Guidelines or MCG Guidelines for Residential Behavioral Health Level of Care.

Plaintiffs in the class action lawsuit accused Anthem of denying claims for mental health and substance use disorder treatment based on medical necessity guidelines that were more restrictive than generally accepted standards of care. These guidelines allegedly violated the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act.

Anthem, now known as Elevance Health, is a health insurance company that offers a variety of plans, including employer-sponsored plans.

Anthem has not admitted any wrongdoing but agreed to a $12.875 million class action settlement to resolve the allegations.

Under the terms of the Anthem class action settlement, class members can receive a reimbursement for out-of-pocket expenses related to residential treatment services. Claimants who submit proof of payment for an episode of residential treatment that began no later than 14 days after a qualifying denial can receive a pro rata share of the reimbursement fund. The maximum number of days of residential treatment that will be eligible for reimbursement is 365 days per treatment episode.

Class members who do not receive a pro rata reimbursement will receive a nominal payment of at least $100.

The deadline for exclusion and objection is Dec. 19, 2025.

The final approval hearing for the Anthem class action settlement is scheduled for Jan. 26, 2026.

To receive settlement benefits, class members must submit a valid claim form by Jan. 20, 2026.

Who’s Eligible

The Anthem mental health treatment class action settlement benefits individuals who were covered by a health benefit plan governed by ERISA that required covered services to be provided in accordance with generally accepted standards of medical practice and whose requests for coverage of residential treatment services for a behavioral health disorder were denied for lack of medical necessity by Anthem on or after April 29, 2017.

The settlement class includes those whose requests were denied based on Anthem’s Clinical UM Guidelines or the MCG Guidelines for Residential Behavioral Health Level of Care and whose denials were not reversed on administrative appeal. The class period is April 29, 2017, to April 30, 2025.

Potential Award

Reimbursement of out-of-pocket expenses or a $100 nominal payment.

Proof of Purchase

Proof of payment must establish that the class member paid out of pocket for an episode of residential treatment that began no later than 14 days after a qualifying denial. The maximum number of days of residential treatment that will be eligible for reimbursement from the out-of-pocket reimbursement fund is 365 days per recognized RTC treatment episode.

Claim Form

NOTE: If you do not qualify for this settlement do NOT file a claim.

Remember: you are submitting your claim under penalty of perjury. You are also harming other eligible Class Members by submitting a fraudulent claim. If you’re unsure if you qualify, please read the FAQ section of the Settlement Administrator’s website to ensure you meet all standards (Top Class Actions is not a Settlement Administrator). If you don’t qualify for this settlement, check out our database of other open class action settlements you may be eligible for.

Claim Form Deadline

01/20/2026

Case Name

Collins, et al. v. Anthem Inc., et al., Case No. 2:20-cv-01969-FB-SIL, in the U.S. District Court for the Eastern District of New York

Final Hearing

01/26/2026

Settlement Website

Anthem-RTC-Criteria-Settlement.com

Claims Administrator

Collins v. Anthem Inc. Settlement Administrator
c/o Simpluris
P.O. Box 25226
Santa Ana, CA 92799
[email protected]
844-496-0857

Class Counsel

Caroline E. Reynolds
Jason Cowart
ZUCKERMAN SPAEDER LLP

Meiram Bendat
PSYCH-APPEAL INC

Julie Selesnick
BERGER MONTAGUE P.C.

Defense Counsel

Rebecca R. Hanson
CROWELL & MORING LLP