Anthem $12.88M Insurance Denial Class Action Settlement

Individuals whom 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, may be eligible to submit a claim for $100 or more from a class action settlement.

Anthem Inc. agreed to pay $12.88 million to settle a class action lawsuit alleging it improperly denied coverage for residential treatment services for mental health and substance use disorders. The lawsuit claims Anthem used more restrictive criteria 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 had a health benefit plan governed by the Employee Retirement Income Security Act of 1974 where the plan required that covered services be provided in accordance with generally accepted standards of medical practice.
• Anthem UM Services Inc. denied their request for coverage of residential treatment services for a behavioral health disorder for lack of medical necessity by 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. They do not need to submit a claim to receive this payment.
• Pro rata out-of-pocket reimbursement: Class members can 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. To qualify for reimbursement, treatment must have began either before the denial or within 14 days after denial. Class members can submit a claim to receive reimbursement for up to 365 days of treatment. The settlement administrator will determine the final payment amount by the number of valid claims submitted.

How to claim a Blue Cross Blue Shield class action payment

To receive reimbursement for out-of-pocket expenses, class members must submit a claim form by Jan. 20, 2026. They can file a claim online using the online claim form or print and mail 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

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

$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?

The settlement administrator will distribute payments after it completes claim processing and the court grants final approval of the settlement.

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