The class-action lawsuit accuses the payer of wrongly refusing to cover residential eating disorder treatment by relying on medical necessary criteria that conflicted with generally accepted standards of medical practice, according to the report.
The settlement applies to as many as 2,281 California residents covered by Anthem health plans, according to the report. The settlement allows the residents to resubmit claims for treatment under a broader medical necessity criteria, up to a $400,000 cap for all claims. It also allows class members to instead receive a set payment of $5,500 or $2,100 depending on whether they continued treatment after denial.
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