Anthem $12.88M Settlement Over Denied Residential Treatment: Claims Are Closed
This case is about a specific and consequential allegation: that Anthem judged residential mental health and addiction treatment against criteria <strong>stricter than generally accepted medical standards</strong>. Claims closed on <strong>20 January 2026</strong> — but the standard the case turned on still governs your coverage today.
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Reviewed by Leonard Goldberg, Editor · Last updated
What the Case Was About
The class action alleges that Anthem, Inc. and Anthem UM Services, Inc. denied coverage requests for residential treatment of mental health conditions and substance use disorders by determining that the care was not medically necessary — and that in doing so, Anthem applied medical necessity criteria more restrictive than generally accepted standards of care, more restrictive than the terms of the health plans themselves, and more restrictive than the criteria used for comparable medical services. That last comparison is the legal heart of it. The claims arise under ERISA and the Mental Health Parity and Addiction Equity Act of 2008, which requires that limits on mental health and substance use benefits be no more restrictive than those applied to medical and surgical benefits. Anthem denies all of the allegations. The settlement is $12,880,000.
Case Details
The case is Collins, et al. v. Anthem, Inc., Case No. 2:20-cv-01969-FB-SIL, in the U.S. District Court for the Eastern District of New York. The class period runs from 29 April 2017 to 30 April 2025. The exclusion and objection deadline was 19 December 2025, the claim deadline was 20 January 2026, and the fairness hearing was held on 26 January 2026. The official website is anthem-rtc-criteria-settlement.com.
Status as of 24 August 2026
Who Was in the Class
Individuals covered by an ERISA-governed health benefit plan that required covered services to be provided in accordance with generally accepted standards of medical practice, and whose requests for coverage of residential treatment services for a behavioural health disorder were denied for lack of medical necessity by Anthem on or after 29 April 2017, through 30 April 2025. Two qualifiers do the work: the plan had to be employer-sponsored and ERISA-governed (individual marketplace plans, Medicare and Medicaid follow different rules), and the denial had to be specifically for lack of medical necessity — not for network, eligibility or administrative reasons.
What the Settlement Paid — and the Rule That Outlives It
How This Case Developed
- 1
29 April 2017 — the class period opens
Denials of residential behavioural health treatment for lack of medical necessity from this date fall inside the class.
- 2
The lawsuit
Collins et al. v. Anthem, Inc. is filed in the Eastern District of New York, alleging Anthem applied medical necessity criteria more restrictive than generally accepted standards, plan terms, and the criteria used for comparable medical services.
- 3
30 April 2025 — the class period closes
The end of the window of denials covered by the settlement.
- 4
19 December 2025 — exclusion and objection deadline
The last day for class members to opt out of the settlement or object to its terms.
- 5
20 January 2026 — claims close
The claim filing deadline passes. Late claims are not accepted.
- 6
26 January 2026 — fairness hearing
The court considers final approval of the $12.88 million settlement. Distribution follows approval and any appeals.
Three Things to Ignore
A closed healthcare settlement with payments still pending is standard territory for impostors.
“File your Anthem claim now”
The deadline was 20 January 2026 and late claims are not accepted. A claim form offered for this settlement today describes a process that has ended.
A fee to “release” your settlement payment
Court-appointed administrators never charge class members to receive or track a payment. Every such request is fraud.
Callers asking to “verify” your member ID and Social Security number
Health insurance identifiers are prime targets for medical identity theft. The administrator communicates through the official settlement website and mail, not unsolicited calls.
Common Questions
Can I still file a claim?
No. The claim deadline was 20 January 2026 and late claims are not accepted under the settlement's terms.
What did the settlement pay?
Reimbursement of out-of-pocket expenses, or a nominal payment of at least $100 for class members who did not receive a pro rata reimbursement.
My treatment was denied after April 2025. What can I do?
You are outside this class, but the underlying rights still apply: request the specific medical necessity criteria used, file an internal appeal, and if that fails, request independent external review. The Parity Act applies regardless of any settlement.
What is the Parity Act?
The Mental Health Parity and Addiction Equity Act of 2008. It requires that limits on mental health and substance use benefits be no more restrictive than those applied to comparable medical and surgical benefits — the standard at the centre of this case.
Was my plan ERISA-governed?
Most employer-sponsored group health plans are. Individual marketplace plans, Medicare, Medicaid and church or government plans follow different rules; your plan documents or HR department can confirm.
When will payments arrive?
After final approval becomes effective and any appeals resolve, then validation. We found no confirmation as of 24 August 2026 that distribution has completed.
Is this the Blue Cross Blue Shield antitrust settlement?
No. That is a separate, much larger case about competition among BCBS licensees. This one concerns denials of residential behavioural health treatment under ERISA and the Parity Act.
How do I verify this page?
Through anthem-rtc-criteria-settlement.com and the docket for Collins et al. v. Anthem, Inc., No. 2:20-cv-01969-FB-SIL (E.D.N.Y.). The dates here were read from the official settlement FAQ on 24 August 2026.
Separate from this case: were you injured in the last 2 years?
Class-action payouts are fixed amounts through an administrator. A personal injury claim is a different case — and often worth far more. Free estimate, no obligation.