Who qualifies for the Anthem mental health residential treatment settlement?

You are in the settlement class if Anthem, Inc. or Anthem UM Services, Inc. denied a request for coverage of residential treatment services for a behavioral health disorder for lack of medical necessity between April 29, 2017 and April 30, 2025, based on Anthem Clinical UM Guidelines or MCG Guidelines, and the denial was not reversed on administrative appeal, under an ERISA health plan that required care to follow generally accepted standards of medical practice.

What is the settlement amount?

Anthem agreed to pay $12,875,000 to resolve the case, subject to Court approval. The fund will pay for notice and administration, attorneys' fees and costs, any service awards, reimbursement of approved out of pocket expenses, and nominal payments to class members.

How much will I get paid?

Class members who submit approved claims for out of pocket expenses will receive pro rata reimbursement from the Out of Pocket Reimbursement Fund, and all remaining class members will receive a nominal payment that will not be less than $100. The final amount per person depends on how many valid claims are filed and the size of those claims.

When is the Fairness Hearing?

The Court scheduled the Fairness Hearing for January 26, 2026, at 11:00 a.m., at the United States District Court for the Eastern District of New York, 225 Cadman Plaza East, Brooklyn, NY 11201.

How do I submit a claim?

You can submit a claim online at www.anthem-rtc-criteria-settlement.com or by mailing a completed paper claim form with proof of payment to the settlement administrator by January 20, 2026.

Anthem Mental Health Residential Treatment $12.875M Class Action Settlement

Q: Is Anthem the same as Blue Cross Blue Shield?

No. Blue Cross Blue Shield is a national association of independent health insurers that license the BCBS name. Anthem is one of those insurers and operates certain local BCBS plans under names like Anthem Blue Cross and Anthem Blue Cross Blue Shield in some states, while other BCBS plans are run by different companies that are not Anthem.

By Steve Levine

Anthem mental health residential treatment class action settlement

Published: November 27, 2025

Status: Proposed Settlement

Settlement Amount: $12,875,000

Claim Form Deadline: January 20, 2026 (for out of pocket reimbursement claims)

Proof required: Yes, for reimbursement of out of pocket expenses

What is the Anthem Class Action About?

You may be part of a new $12.875 million class action settlement reached with Anthem, Inc. and Anthem UM Services, Inc. over allegations that Anthem used overly restrictive medical necessity criteria to deny coverage for residential treatment of mental health conditions and substance use disorders.

The lawsuit, Collins et al. v. Anthem Inc., et al., claims that Anthem violated ERISA and the Mental Health Parity and Addiction Equity Act by creating and applying guidelines that were more restrictive than generally accepted standards of care and more restrictive than the terms of the health benefit plans and the criteria used for comparable medical and surgical services.

Anthem denies all wrongdoing and denies that it violated ERISA, the Parity Act, or any other law. The parties agreed to settle in order to avoid the cost and uncertainty of continued litigation.

What is the Total Settlement Amount?

Anthem agreed to create a $12,875,000 settlement fund. This fund will pay for notice and administration costs, attorneys fees and expenses, any service awards for the class representatives, reimbursement of approved out of pocket expenses, and nominal payments to all other class members who stay in the class.

How Do I Qualify For a Payout?

You may qualify if:

• You were a member of an ERISA governed health benefit plan administered by Anthem that required covered services to follow generally accepted standards of medical practice, and
• Anthem UM Services, Inc. denied your request for coverage of residential treatment services for a behavioral health disorder for lack of medical necessity on or after April 29, 2017, and
• The denial was based on Anthem Clinical UM Guidelines or MCG Guidelines for Residential Behavioral Health Level of Care, and
• The denial was not reversed on administrative appeal, and
• The denial occurred between April 29, 2017 and April 30, 2025.

If you received a notice about this settlement, Anthem's records indicate that you are in the class unless you opt out.

How Much Can I Get Paid?

There are two types of payments:

1. Pro rata reimbursement payments for class members who submit valid claims with proof of out of pocket payments for residential treatment that began within 14 days after a qualifying denial, up to a maximum of 365 days per treatment episode. These payments will be based on the amount you paid and how many other class members submit valid claims.

2. Nominal payments for all other class members who do not receive a reimbursement payment. The settlement guarantees that this nominal payment will not be less than $100 for each class member who stays in the settlement and does not receive reimbursement.

How Do I File a Claim?

You only need to file a claim if you are seeking reimbursement of out of pocket expenses.

• Online: Visit the official settlement website and submit a claim form with your contact information and proof of payment showing what you paid for residential treatment that started within 14 days after a qualifying denial.
• By mail: Complete and sign a paper claim form, attach copies of your proof of payment, and mail it to the settlement administrator at the address listed on the form.

If you do not file a claim, you will still receive the nominal payment of at least $100 as long as you are in the class and do not opt out.

What is the Claim Form Deadline?

The deadline to submit a claim for reimbursement of out of pocket expenses is January 20, 2026.

Claim forms must be submitted online by that date or postmarked by that date if mailed.

How Many People are Affected?

The official notice does not list a specific number of affected people. The settlement class includes all ERISA plan members whose requests for coverage of residential treatment for behavioral health disorders were denied for lack of medical necessity by Anthem using the challenged guidelines between April 29, 2017 and April 30, 2025, and whose denials were not reversed on appeal. That group is expected to include a significant number of patients and families.

What are the Important Dates?

Key dates include:

• Opt out deadline: December 19, 2025
• Objection deadline: December 19, 2025
• Claim deadline for reimbursement of out of pocket expenses: January 20, 2026
• Fairness Hearing (Final Approval Hearing): January 26, 2026 at 11:00 a.m. Eastern Time, at the United States District Court for the Eastern District of New York, 225 Cadman Plaza East, Brooklyn, NY 11201

When is the class action settlement payment date?

The exact payment date has not been set. Payments will be made only after the Court grants final approval of the settlement, any appeals are resolved, and the settlement becomes effective. The settlement administrator will then process valid claims and issue payments. This usually takes several months after the final approval hearing, but timing depends on the Court and any appeals.

Is Proof Required to File a Claim?

• For the automatic nominal payment of at least $100, no claim form or proof is required. If you are in the class and do not opt out, you are expected to receive this payment automatically.

• For reimbursement of out of pocket expenses, you must submit proof of payment, such as invoices, receipts, or account statements that show what you actually paid for residential treatment that started within 14 days after a qualifying denial, up to 365 days per treatment episode.

How Many People are Affected?

The class covers all ERISA plan members whose requests for coverage of residential treatment for behavioral health disorders were denied for lack of medical necessity by Anthem using the challenged guidelines during the class period and whose denials were not reversed on appeal. While the exact number is not published in the notice, it is likely to be a large national class of patients who sought residential treatment for mental health conditions or substance use disorders.

When Will this Class Action Be Certified?

This case has already been certified as a class action. On March 19, 2024, the Court certified the class under Federal Rule of Civil Procedure 23 and appointed the named plaintiffs as class representatives. So certification is complete and not an open question.

What are the Odds This Class Action is Settled?

The parties have already negotiated a detailed written settlement agreement and the Court has approved notice of the proposed settlement. At this stage, the main remaining step is the Fairness Hearing and final approval decision on January 26, 2026, along with any appeals. Compared to an early stage case with no settlement, the chances that this matter ends in a settlement are high, although final approval is still up to the Court.

What is the Anticipated Settlement Amount?

The total settlement amount is $12,875,000.

This is the gross fund before deductions for administration, attorneys fees and costs, and any service awards for the class representatives.

How much will Each Class Action Claimant be Paid?

Payment amounts will vary based on each class member's situation.

• Class members who submit approved claims with proof of out of pocket payments may receive higher pro rata reimbursement amounts, depending on the number of days of residential treatment and the total number and size of valid claims.
• All other class members who do not receive reimbursement will receive a nominal payment that will not be less than $100.

The final per person amounts cannot be predicted now because they depend on how many people file valid claims and the total reimbursable out of pocket amounts.

What are the odds that the class action will be certified and settled and eventually pay out?

For this particular case:

• Certification: The class has already been certified, so the odds of certification are effectively one hundred percent.
• Settlement approval: A full settlement agreement is in place with a defined fund. Notice has gone out and a Fairness Hearing is scheduled, so the settlement is in an advanced stage. While the Court must still grant final approval, the chances of some form of settlement approval are strong compared to a case with no settlement agreement yet.
• Eventual payout: If the Court grants final approval and any appeals do not overturn the settlement, payments should be made to class members from the settlement fund. The main remaining uncertainties are the timing of payments and the exact amount each class member will receive, not whether payments will occur at all.

Is Anthem the Same as Blue Cross Blue Shield?

Anthem and Blue Cross Blue Shield are related in many states but are not the same company. Blue Cross Blue Shield is a national association of independent health insurers that license the BCBS name and logo. Anthem is one of those insurers and operates some local Blue Cross and Blue Shield plans under names like Anthem Blue Cross or Anthem Blue Cross Blue Shield in certain states. In other states, BCBS plans are run by completely separate companies that are not Anthem.

How Do I Find Class Action Settlements?

Find all the latest class actions you can qualify for by getting notified of new lawsuits as soon as they are open to claims:

Claim Form Website: Anthem-RTC-Criteria-Settlement.com

Submit Claim

Official Settlement Notice

Sources

• Official Settlement Website: www.anthem-rtc-criteria-settlement.com
• United States District Court for the Eastern District of New York, Collins et al. v. Anthem Inc., et al., Case No. 2:20-cv-01969-FB-SIL

Filing Class Action Settlement Claims

Please submit only truthful information. False or fraudulent claims can be rejected and may carry penalties. If you are unsure whether you qualify, review the official notice or contact the settlement administrator. OpenClassActions.com is a consumer news site and is not a settlement administrator or a law firm.

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Class Action Summary
Status	Proposed Settlement
Claim Form Deadline	January 20, 2026 (for out of pocket reimbursement claims)
Settlement Amount	$12,875,000
Category	Health insurance and mental health parity
Estimated Payout per Person	Nominal payment of at least $100 for class members who do not receive reimbursement. Higher pro rata amounts possible for approved reimbursement claims.
Case Number	2:20-cv-01969-FB-SIL
Case Title	Collins et al. v. Anthem Inc., et al.
Court	U.S. District Court for the Eastern District of New York
Final Approval Hearing	January 26, 2026 at 11:00 a.m. Eastern Time
Claim Website	Anthem-RTC-Criteria-Settlement.com
Administrator	Simpluris, Settlement Administrator