Anthem $12.88M Insurance Denial Class Action Settlement

If Anthem or Anthem UM Services Inc. denied a claim for health insurance coverage for residential treatment of a mental health condition or substance use disorder between April 29, 2017, and April 30, 2025, individuals may be eligible to submit a claim for $100 or more from a class action settlement.

Anthem Inc. has agreed to pay $12.88 million to settle a class action lawsuit alleging that it improperly denied coverage for residential treatment services for mental health and substance use disorders. The lawsuit claims Anthem used criteria that were more restrictive than generally accepted standards of care, in violation of federal law.

Who is eligible for an Anthem settlement payment?

Class members must meet the following criteria:

• They covered by a health benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), where the plan required that covered services be provided in accordance with generally accepted standards of medical practice.
• They had a request for coverage of residential treatment services for a behavioral health disorder denied for lack of medical necessity by Anthem UM Services Inc. on or after April 29, 2017.
• They received a denial based on Anthem’s Clinical UM guidelines or the MCG guidelines for residential behavioral health level of care.
• They did not have the denial reversed on administrative appeal.
• The denial took place between April 29, 2017, and April 30, 2025.

How much is the class action payout?

Class members have the following options:

• Cash payment: All class members will receive a cash payment of at least $100. A claim does not need to be submitted or approved to receive this payment.
• Pro rata out-of-pocket reimbursement: Class members can also submit a claim for documented out-of-pocket payments for residential treatment that Anthem denied coverage for between April 29, 2017 and April 30, 2025. In order to qualify for reimbursement, treatment must have began either before the denial or within 14 days after denial. Class members can submit to receive reimbursement for up to 365 days of treatment. Final payment amount will be determined by the number of valid claims submitted.

How to claim a Blue Cross Blue Shield class action payment

In order to receive reimbursement for out-of-pocket expenses, class members must submit a claim form by Jan. 20, 2026. . Claims can be filed online using the online claim form or by printing and mailing the PDF claim form to the settlement administrator.

Settlement administrator's address: Collins v. Anthem, Inc. Settlement Administrator, c/o Simpluris, P.O. Box 25226, Santa Ana, CA 92799

Required out-of-pocket claim information and proof

• Notice ID and PIN from official settlement notice required to submit an online claim for out-of-pocket expenses.
• Claimants submitting an out-of-pocket reimbursement claim must provide their date of birth, Social Security number, Anthem group number and Anthem ID number.
• Claimants submitting an out-of-pocket reimbursement claim must include supporting documentation showing residential treatment expenses. Proof should include residential treatment name, address, and phone number, dates of admission and discharge, total amount charged by the treatment center, total amount paid by insurance (if any), total amount paid out-of-pocket and proof of payment.
• Claimants submitting an out-of-pocket must provide proof of payment, which may include account statement, invoice or bill from the residential treatment center showing paid, credit card or bank statement showing payment or cancelled check.

$12.88 million settlement fund

The $12,880,000 settlement fund will include:

• Settlement administration costs: $250,000 or more
• Attorneys' fees and costs: Not to exceed $4,291,237.50
• Service awards to class representatives: $10,000 each
• Payments to eligible class members: Remaining settlement funds

Important dates

• Opt-out deadline: Dec. 19, 2025
• Claim deadline: Jan. 20, 2026
• Fairness hearing: Jan. 26, 2026, at 11 a.m.

When is the Blue Cross Blue Shield Anthem settlement payout date?

Payments will be distributed after the court grants final approval and claim processing is completed.

Why did this class action settlement happen?

The class lawsuit alleged that Anthem Inc. and Anthem UM Services Inc. denied coverage for residential treatment of mental health and substance use disorders using criteria that were more restrictive than generally accepted standards of care, violating ERISA and the Mental Health Parity and Addiction Equity Act. Anthem denies the allegations but agreed to settle to avoid the expense and risk of continued litigation.

Sources

1. Official class notice
2. Official settlement website FAQ
3. Official claim form