Anthem has settled a class action lawsuit brought by participants in employee health plans it administers, following negotiations and private mediation. The plan participants claim that Anthem violated the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) by improperly denying coverage for inpatient mental health and substance use disorder treatment based on impermissibly restrictive eligibility criteria.
The settlement comes after a New York federal district court certified the class of plaintiffs in March 2024 and issued an injunction for reprocessing benefits claims and declaratory relief on the ERISA claims. The case is Marissa Collins et al. v. Anthem Inc. et al., case number 2:20-cv-01969, U.S. District Court for the Eastern District of New York.
Marissa Collins, who participated in her husband's ADP employee health plan that Anthem administered, filed suit against Anthem and its affiliate, Anthem UM Services Inc., in April 2020. She claimed that Anthem applied overly strict criteria in processing mental and health and substance abuse disorder claims, which contradicted the medical necessity criteria in the plan. Federal law prohibits insurance companies from using more restrictive coverage criteria for mental health treatment than it does for medical/surgical treatment.
Anthem moved to dismiss the case, which the court denied in February 2022. Later that year, the court also allowed a Verizon Wireless employee insured through Anthem to intervene in the case seeking reimbursement for inpatient treatment for his covered minor child.
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