Individuals whose claims for residential treatment coverage were denied by Anthem between 2017 and 2025 may qualify to receive $100 or more from a class action settlement.
Overview
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 conditions and substance use disorders. The lawsuit claims Anthem used criteria more restrictive than generally accepted standards of care, in violation of federal law.
The settlement covers individuals whose claims were denied between April 29, 2017, and April 30, 2025.
Who Is Eligible
To qualify as a class member, all of the following must apply:
- You were covered by a health benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA) that required covered services to follow generally accepted standards of medical practice.
- Anthem UM Services Inc. denied coverage for residential treatment services for a mental health condition or substance use disorder due to lack of medical necessity.
- The denial was based on Anthem’s Clinical Utilization Management guidelines or MCG guidelines for residential behavioral health care.
- The denial was not reversed through an administrative appeal.
- The denial occurred between April 29, 2017, and April 30, 2025.
Settlement Benefits
Class members may receive compensation in one of the following ways:
- Automatic cash payment: All eligible class members will receive a cash payment of at least $100. No claim form is required for this payment.
- Out-of-pocket reimbursement: Class members who paid out of pocket for residential treatment that Anthem denied may submit a claim for reimbursement. Treatment must have begun before the denial or within 14 days after the denial. Claims may cover up to 365 days of treatment. Reimbursement amounts will be determined on a pro rata basis depending on the number of valid claims submitted.
How to File a Claim for Reimbursement
To seek reimbursement for out-of-pocket expenses, class members must submit a claim form by January 20, 2026. Claims may be filed online or by mailing a completed PDF claim form.
Mailing address:
Collins v. Anthem Inc. Settlement Administrator
c/o Simpluris
P.O. Box 25226
Santa Ana, CA 92799
Information and Documentation Required
For out-of-pocket reimbursement claims, claimants must provide:
- Notice ID and PIN from the official settlement notice (for online claims).
- Date of birth, Social Security number, Anthem group number, and Anthem ID number.
- Documentation showing residential treatment expenses, including the treatment facility’s name, address, phone number, dates of admission and discharge, total charges, insurance payments (if any), and out-of-pocket amounts paid.
- Proof of payment, such as invoices, billing statements, credit card or bank statements, or canceled checks.
Settlement Fund Allocation
The $12,880,000 settlement fund will be used for:
- Settlement administration costs of $250,000 or more
- Attorneys’ fees and costs, not to exceed $4,291,237.50
- Service awards of $10,000 each to class representatives
- Remaining funds distributed to eligible class members
Important Dates
- Opt-out deadline: December 19, 2025
- Claim deadline: January 20, 2026
- Fairness hearing: January 26, 2026, at 11:00 a.m.
Payment Timing
Payments will be issued after the court grants final approval of the settlement and the settlement administrator completes claim processing.
Reason for the Settlement
The lawsuit alleged that Anthem Inc. and Anthem UM Services Inc. denied coverage for residential treatment of mental health and substance use disorders using overly restrictive criteria, in violation of ERISA and the Mental Health Parity and Addiction Equity Act. Anthem denies wrongdoing but agreed to settle to avoid continued litigation.
Award
At least $100, plus a possible pro rata share of approved out-of-pocket expenses.
Deadline
January 20, 2026.
