The legal battle over mental health treatment coverage took a dramatic turn Friday as a New York federal judge granted preliminary approval to Anthem’s $12.9M ERISA deal, which aims to resolve claims that the insurer improperly denied residential behavioral health treatment under employer-sponsored plans.
U.S. Magistrate Judge Steven I. Locke approved the $12.875 million settlement to advance, setting the stage for a final hearing expected early next year. For thousands of policyholders, the ruling opens the door to long-awaited compensation.
Relief for Patients Denied Care
At the heart of the dispute were allegations that Anthem’s utilization review guidelines wrongly labeled certain residential treatment for mental health and substance use disorders as not medically necessary. Families argued the denials left them without critical care during life-threatening crises.
Under the agreement, eligible ERISA plan members whose claims were denied will receive either a guaranteed $100 minimum payout or a pro rata reimbursement from the fund, depending on the number of valid claims filed. Payments will be distributed after deducting attorney fees, expenses, and settlement administration costs.
