Anthem has reached a settlement in a case alleging its standards for residential mental health coverage were unnecessarily strict.
According to an April 15 joint-status filing, Anthem and the plaintiffs in the case reached an agreement in principle on the terms of a settlement. The details of the settlement were not disclosed in the filing.
Here are three things to know:
- The lawsuit has been ongoing for five years. In April 2020, two Anthem plan members sued the insurer, alleging they were denied coverage for medically necessary inpatient mental health treatment.
- The plaintiffs alleged Anthem’s criteria for residential mental health coverage was not in line with generally accepted medical guidance. The lawsuit also alleged the insurer violated the Mental Health and Addiction Equity Act of 2008 by applying more stringent utilization management to mental health than for physical healthcare.
- In 2022, a judge denied Anthem’s request to dismiss the case.
Anthem rebranded as Elevance Health in 2022.
The two parties proposed a May 30 deadline to file details of the proposed settlement with the court.
Becker’s has reached out to Anthem for comment and will update this article if more information becomes available.
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