The Anthem $12.8M Class Action Settlement allows eligible policyholders to seek compensation for out-of-pocket costs tied to denied residential behavioral health treatment, according to federal court records.
The settlement resolves years of litigation and requires eligible claimants to submit forms by January 20 to receive payment.
Anthem $12.8M Class Action Settlement
| Key Fact | Detail |
|---|---|
| Total Settlement Fund | $12.875 million |
| Defendant | Anthem, Inc. |
| Claim Deadline | January 20 |
| Covered Period | April 29, 2017 – April 30, 2025 |
| Minimum Payment | $100 per approved claimant |
What Is the Anthem $12.8M Class Action Settlement?
The Anthem $12.8M Class Action Settlement stems from a lawsuit alleging that Anthem improperly denied coverage for residential treatment services for mental health and substance use disorders. Plaintiffs argued that Anthem relied on internal medical-necessity criteria that were more restrictive than generally accepted clinical standards.
Residential treatment typically involves structured, live-in care for individuals with serious behavioral health conditions. Such treatment is often recommended when outpatient care is insufficient. The lawsuit alleged that Anthem’s coverage decisions resulted in significant financial hardship for patients and families.
Anthem has denied all allegations of wrongdoing. In settlement filings, the company stated that it agreed to resolve the case to avoid the uncertainty, cost, and duration of continued litigation.
“The settlement reflects a compromise of disputed claims and does not constitute an admission of liability,” Anthem said in a court filing.
Legal Background: Why ERISA Matters
The lawsuit was brought under the Employee Retirement Income Security Act of 1974 (ERISA), a federal law governing most employer-sponsored health plans. ERISA sets standards for benefit administration and allows plan participants to challenge coverage decisions in federal court.
Legal experts note that ERISA cases often focus on whether insurers applied plan terms fairly and consistently.
“ERISA litigation frequently turns on how discretion is exercised by plan administrators,” said a health law scholar at a U.S. law school. “Coverage criteria must align with plan language and federal parity requirements.”
Who Is Eligible to File a Claim For Anthem $12.8M Class Action Settlement?
Eligibility is limited to individuals who meet all of the following criteria:
Insurance Coverage
- You were covered by an ERISA-governed, employer-sponsored health plan.
- Anthem served as the plan administrator or made benefit determinations.
Coverage Denial
- Anthem denied coverage for residential treatment services for a behavioral health condition.
- The denial occurred between April 29, 2017, and April 30, 2025.
Out-of-Pocket Costs
- You paid some or all treatment costs out of pocket after the denial.
Individuals who opted out earlier or who never paid out of pocket are not eligible.
Guide to Claim Before January 20
- Use the Official Settlement Website: Claims must be submitted through the court-approved settlement administrator. Using unofficial sites may lead to fraud or rejected submissions.
- Review Eligibility Carefully: Before filing, confirm:
- Your plan was ERISA-governed
- Anthem denied residential treatment coverage
- You incurred out-of-pocket expenses
- Gather Supporting Documentation: While not always required, documentation helps verify claims. Recommended records include:
- Anthem denial letters
- Treatment invoices
- Proof of payment
- Insurance plan details
- Complete the Claim Form: Claimants must provide accurate information, including:
- Contact details
- Insurance plan information
- Dates of denial
- Amounts paid
- Forms must be certified as truthful.
- Submit Before January 20: Claims must be submitted online or postmarked by January 20. Courts rarely accept late claims.
How Settlement Payments Are Calculated
Pro Rata Distribution
If sufficient funds remain, payments may be proportional to documented out-of-pocket expenses.
Minimum Payment
If claims exceed available funds, each approved claimant will receive at least $100, regardless of expenses. Administrative costs and attorney fees are deducted from the settlement fund before distributions.
What Happens After You File?
Claims Review
The settlement administrator verifies eligibility and documentation.
Final Approval Hearing
A federal judge will evaluate whether the settlement is fair, reasonable, and adequate.
Payment Distribution
If approved, payments are issued by check or electronic transfer, often several months later.
Timeline of the Anthem $12.8M Class Action Settlement
- 2017–2025: Alleged coverage denials occur
- Case filed: Plaintiffs challenge Anthem’s criteria
- Settlement reached: Parties agree to $12.8M fund
- Claim deadline: January 20
- Final hearing: Scheduled following claims review
What Happens to Unclaimed Funds?
If funds remain after valid claims are paid, the settlement agreement specifies how they will be handled. Options may include:
- Additional distributions to claimants
- Donations to court-approved nonprofit organizations
The final outcome depends on court approval.
Mental Health Parity and Broader Implications
The case highlights ongoing disputes over mental health parity laws, which require insurers to treat behavioral health coverage comparably to physical health coverage. Regulators and courts have increasingly scrutinized insurer practices, though settlements like this one do not establish legal precedent.
Consumer Warnings and Fraud Prevention
Settlement administrators caution claimants to:
- Avoid third-party “claims assistance” services that charge fees
- Never share sensitive information outside the official site
- Retain copies of all submissions
Legitimate settlements do not require upfront payments to file a claim.
Related Links
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The Anthem $12.8M Class Action Settlement offers limited but meaningful compensation for eligible policyholders affected by disputed coverage denials. With the January 20 deadline approaching, potential claimants must act promptly to preserve their rights under the agreement.
FAQs About Anthem $12.8M Class Action Settlement
Does Anthem admit wrongdoing?
No. The settlement includes no admission of liability.
Can I file if I lost my denial letter?
Yes, if you can otherwise verify eligibility.
How long until payments arrive?
Typically several months after final court approval.
Are payments taxable?
Tax treatment varies. Claimants should consult a tax professional.
