Anthem class action settlement: Health insurer Anthem has agreed to pay $12.875 million to settle a class action lawsuit, marking a formal resolution to claims involving denied coverage for certain residential treatment services. Anthem now operates under the name Elevance Health and provides health insurance plans, including employer-sponsored coverage, as per a report.

Anthem agrees to $12.875 million class action settlement: Lawsuit challenges denied residential treatment coverage

The lawsuit alleged that Anthem improperly denied coverage requests for residential treatment services by determining that the care was not medically necessary. Plaintiffs claimed the insurer rejected "certain coverage requests for residential treatment services, determining that the care was not medically necessary" by applying "criteria that were more restrictive than generally accepted standards of care," as quoted by The Express.

Anthem denies wrongdoing, settles to avoid litigation risk

Anthem has denied any wrongdoing but agreed to the settlement to avoid the expense and uncertainty of continued litigation. A final approval hearing for the settlement is scheduled for January 26, 2026.

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Who qualifies for the Anthem settlement payment

Under the agreement, customers whose claims for residential treatment related to a mental health condition or substance use disorder were denied by Anthem between April 29, 2017, and April 30, 2025, may be eligible to file a claim. To qualify, customers must submit the required documentation.

How settlement payouts will be calculated

Eligible class members will receive either a proportional share of the Out-of-Pocket Reimbursement Fund or a minimum payment of at least $100. Proof of payment must show that the individual paid out of pocket for an episode of residential treatment that began within 14 days of a qualifying denial.

Deadline to file an Anthem settlement claim

To receive settlement benefits, class members must submit a valid claim form by January 20, 2026.

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What happens if class members take no action

As per the settlement website, "To remain a Class Member for the Settlement, you do not need to do anything. You automatically will be included in the Class, and you will receive a Nominal Payment from the Settlement Fund. If you remain in the Class, you will give up your right to sue Anthem for claims relating to the subject matter of the Lawsuit," as quoted by The Express.

FAQs

How much is the Anthem settlement worth?
The total settlement amount is $12.875 million.

What is the lawsuit about?
It involves denied coverage for certain residential treatment services.