Healthcare
High Payout
Anthem Residential Treatment Criteria Class Action Settlement
If Anthem denied your residential treatment coverage for mental health or substance use from Apr 29, 2017–Apr 30, 2025, claim reimbursement for out-of-pocket costs. Proof required for full amount.
Settlement Overview
The Anthem Residential Treatment Criteria Class Action Settlement (Collins, et al. v. Anthem, Inc.) resolves allegations that Anthem, Inc. and Anthem UM Services, Inc. violated the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act of 2008 by denying health insurance coverage for residential treatment of mental health conditions or substance use disorders. Defendants allegedly applied more restrictive medical necessity criteria than for comparable medical/surgical services or generally accepted standards, leading to improper denials under employer-sponsored plans.
Anthem denies all wrongdoing and liability but agreed to this settlement to avoid the costs and uncertainties of litigation. The settlement provides monetary relief for out-of-pocket expenses paid after denials, plus a pro rata share of any remaining fund after deductions for fees, costs, and administration. Class members release Anthem from related ERISA and Parity Act claims. Non-monetary relief includes enhanced training and policy reviews for future claims. For complete terms, review the official Long Form Notice and Settlement Agreement on the settlement website.
Who Is Eligible?
You are eligible as a U.S. Class Member if:
- You participated in an Anthem-administered employer-sponsored health plan.
- Anthem denied your claim for coverage of residential treatment services for a mental health condition or substance use disorder.
- The denial occurred between April 29, 2017, and April 30, 2025.
No minimum expense amount required; all denials in this period qualify you for at least the nominal payment.
How to File a Claim
1. Visit the official settlement website at https://anthem-rtc-criteria-settlement.com and download or access the online Claim Form (claims are now open).
2. Complete the form with your details, denial information, and attach proof of out-of-pocket payments (e.g., receipts, bills).
3. Submit electronically via the portal or mail postmarked by January 20, 2026, to the Settlement Administrator.
After validation, approved claimants receive payment by check or electronic transfer within 60-90 days post-final approval.
Documentation Requirements
Proof of out-of-pocket expenses is required for reimbursement claims (e.g., dated receipts, bank statements, or invoices showing payment for residential treatment services after the denial).
**Without proof, you automatically receive only the Nominal Payment (a small fixed amount for all inactive class members).
With valid proof, you can claim partial reimbursement based on documented costs, shared pro rata from the fund, potentially higher than nominal but not full recovery. All claims are reviewed for validity, incomplete submissions may default to nominal.
Payout Details
Class members receive either a Nominal Payment (fixed small amount, exact figure TBD based on fund after deductions) if no claim or proof submitted, or partial pro rata reimbursement of documented out-of-pocket expenses (varies by total valid claims and fund size; unlikely to cover 100%). Payments issued post-approval from the non-reversionary settlement fund. Taxes may apply; no interest accrued.
Key Information
Payout Range
Nominal Payment - Full documented (out-of-pocket expenses)
Claim Deadline
January 20, 2026
35 days left
Administrator
JND Legal Administration
Important Dates
Opt-Out: December 19, 2025
Final Approval: January 26, 2026
By clicking "Submit Claim Now", you will be directed to the official settlement website to file your claim directly with the settlement administrator.
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