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California Anthem Blue Cross members can get up to $7,500 from a class action settlement that resolve claims that the insurance company denied mental health treatment coverage.
The settlement benefits California residents who were enrolled in an Anthem Blue Cross Life & Health Insurance Company non-ERISA PPO health plan and who requested coverage for behavior health treatment for a “Co-Morbid” diagnosis between Aug. 18, 2011 and Feb. 4, 2020.
A Co-Morbid diagnosis is both a substance use disorder diagnosis and a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive development disorder or autism, anorexia nervosa, or bulimia nervosa.
Plaintiffs in the Anthem Blue Cross class action lawsuit claim that the health insurance company wrongfully denied their claims for behavior health treatment due to their co-morbid diagnosis.
According to the Anthem Blue Cross class action, the health insurance provider denied coverage by classifying the claims as substance abuse treatment only.
The plaintiffs claim that, because their substance abuse diagnosis was accompanied with another mental health diagnosis, their claims can not be considered only substance abuse treatment. Despite this, Anthem Blue Cross allegedly continued to deny claims for behavioral health treatment.
The Anthem Blue Cross class action lawsuit included claims of violation of California consumer protection laws, breach of contract, breach of implied covenant of good faith and fair dealing, and declaratory relief.
Anthem Blue Cross has denied the allegations against them but agreed to settle the class action in a deal with the plaintiffs.
Under the settlement, Class Members can collect up to $7,750 in compensation. The level of payments depends on whether or not the claimant continued with treatment, how much they were forced to pay out-of-pocket, and whether or not they submit their claims to Anthem for reprocessing.
The settlement also includes measures by Anthem to improve their processing of mental health treatment for the Class Members.
In order to benefit from the settlement, Class Members must file a valid claim form by July 6, 2020. Claims require various forms of documentation including medical records, treatment bills, receipts, credit card statements, and other proof of out-of-pocket expenses.
The deadline for exclusion and objection is May 21, 2020. The final approval hearing is scheduled for Oct. 15, 2020.
Who’s Eligible
California residents who were enrolled in an Anthem Blue Cross Life & Health Insurance Company non-ERISA PPO health plan and who:
- Had a co-morbid diagnosis (both a substance use disorder diagnosis and a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive development disorder or autism, anorexia nervosa, or bulimia nervosa);
- Requested coverage for behavior health treatment between Aug. 18, 2011 and Feb. 4, 2020; and
- Had their request denied or did not make a request due to representations from Anthem or a provider.
Potential Award
Up to $7,750.
Individuals who were denied coverage because Anthem deemed their treatment to be not medically necessary can collect up to $7,750 in reimbursement of out-of-pocket payments or collections amounts. These larger payments are available only for claimants whose treatment Anthem determines should have been authorized. Individuals who do not submit their claims to Anthem for reprocessing can collect up to $2,375 for out-of-pocket expenses or collections amounts.
Individuals who stopped treatment after Anthem denied coverage are eligible to receive a set payment of $1,500. Class Members who recover out-of-pocket expenses may also be eligible for these set payments.
Proof of Purchase
Various forms of documentation including medical records, treatment bills, receipts, credit card statements, and other proof of out-of-pocket expenses.
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
7/6/2020
Case Name
Ames v. Anthem Blue Cross Life & Health Insurance Company, Case No. BC591623, in the Superior Court of the State of California for the County of Los Angeles
Final Hearing
10/15/2020
Settlement Website
Claims Administrator
Ames Settlement Administrator
c/o Rust Consulting Inc. – 6861
PO Box 44
Minneapolis, MN 55440-0044
1-866-403-0681
Class Counsel
Kathryn M. Trepinski
LAW OFFICES OF KATHRYN TREPINSKI
Lisa S. Kantor
KANTOR & KANTOR LLP
Defense Counsel
Molly Moriarty Lane
Lisa Rose Weddle
MORGAN LEWIS & BOCKIUS LLP
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5 thoughts onCalif. Anthem Blue Cross Treatment Denial Class Action Settlement
They are doing the same exact thing here in TN. Wish there were more states than CA to file..
My son attempted suicide twice and we were denied mental health coverage because they deemed it not necessary.
I changed providers because Blue Cross/Anthem denied paying for my antidepressants for the last two years with them.
What about in 2008 they denied my son mental health for anorexia because his duel diagnosis was the medical issues anorexia caused. They refused to pay for Lucille packards children’s hospital In palalto Ca. in 2008 and 2009
They are doing the same thing in Missouri. Can someone get them to cover our bills also. I have the substance abuse problem as well as uncontrollable anxiety and big bouts of depression at times. It costs me 270 dollars to see the Doc when it should cost 25 dollars. This has gone on since 2010.