Thousands of people were denied residential treatment coverage by Anthem between 2017 and 2025. A new $12.88 million class action settlement could mean $100+ cash for affected members — and potentially much more if you paid out-of-pocket.
This guide breaks everything down simply so you can see if you qualify and take action fast.
Why is there a lawsuit?
The lawsuit claims Anthem wrongfully denied requests for residential treatment for mental health conditions and substance use disorders. According to the lawsuit, Anthem used medical necessity criteria that were more restrictive than generally accepted standards of care, the terms of ERISA-governed plans, and comparable medical services.
Anthem denies all wrongdoing but agreed to settle to avoid further litigation.
Who qualifies?
You may be part of the class if all of the following apply:
You were covered by a health plan governed by ERISA.
You requested residential treatment for a behavioral health disorder.
Anthem or Anthem UM Services denied coverage for lack of medical necessity.
The denial was based on Anthem’s Clinical UM Guidelines or MCG guidelines.
The denial was not reversed on administrative appeal.
The denial happened between April 29, 2017, and April 30, 2025.
All qualifying Class Members automatically receive at least $100, even without filing a claim.
How much can people get?
Class Members have two types of benefits:
1. Automatic Cash Payment
All Class Members receive at least $100.
No claim form required.
2. Reimbursement for Out-of-Pocket Expenses (Optional)
If you paid out-of-pocket for treatment that Anthem denied, you may submit a claim for partial reimbursement.
Covers expenses for treatment that began before the denial or within 14 days after.
Can cover up to 365 days of treatment.
Final payout depends on the number of valid claims submitted.
What Are Your Options?
| Option | What It Means | Deadline |
|---|---|---|
| Do Nothing | Stay in the class and automatically receive at least $100. | No action needed |
| Submit a Claim | Request reimbursement for out-of-pocket treatment expenses. | Jan. 20, 2026 |
| Opt Out | Remove yourself from the settlement so you can sue Anthem separately. No settlement money. | Dec. 19, 2025 |
| Object | Tell the Court you disagree with the settlement terms. | Dec. 19, 2025 |
| Attend Fairness Hearing | Speak to the Court about the settlement’s fairness. | Jan. 26, 2026 at 11:00 |
How to File a Claim
You only need to file a claim if you want reimbursement for out-of-pocket expenses.
Step 1: Complete the Claim Form
File online or download the PDF and mail it.
Deadline: January 20, 2026
Step 2: Gather Required Information
For reimbursement claims, you must provide:
Notice ID and PIN (from your official settlement notice)
Date of birth, Social Security number, Anthem group & plan ID
Documentation of treatment (name, dates, charges, proof of payment)
Proof that you personally paid the out-of-pocket costs
Step 3: Submit Your Claim
Mail claims to:
Collins v. Anthem, Inc. Settlement Administrator
c/o Simpluris
P.O. Box 25226
Santa Ana, CA 92799
Payments will be issued after final approval and claim processing.
Class Members automatically receive at least $100, but you’ll need to submit a claim if you want reimbursement for out-of-pocket costs.
