A
Anthem
Anthem agreed to pay $12.88 million to settle claims it denied mental health and substance use disorder treatment coverage based on restrictive guidelines.
ClosedUnited States-wideClaim status: Closed on January 20, 2026Payout: Reimbursement of out-of-pocket expenses or a $100 nominal payment.No longer claimable
About this settlement
Settlement for Anthem policyholders denied residential behavioral health treatment coverage under ERISA plans due to medical necessity denials.
This settlement resolves claims that Anthem denied coverage for residential mental health and substance use disorder treatments based on overly restrictive medical necessity guidelines. Eligible class members may receive reimbursement for out-of-pocket expenses or a nominal payment.
Who qualifies
- Individuals covered by an ERISA-governed health plan requiring services to meet accepted medical standards.
- Those denied residential treatment coverage by Anthem from April 29, 2017 to April 30, 2025.
- Denials based on Anthem’s Clinical UM Guidelines or MCG Guidelines not reversed on appeal.
Reimbursement of out-of-pocket expenses or a $100 nominal payment.
Claim status: Closed on January 20, 2026