Anthem Blue Cross Refusal to Pay Settlement

Settlement Structure: Claims Made

Active: Closed

Closed Settlement Statement:

According to court documents, the claim submission deadline has passed. Please contact the claims administrator if you have any questions.

Case Summary:

Anthem Blue Cross is settling a class action alleging that it refused to pay for treatment for co-morbid diagnoses because it had classified their claims as being for substance abuse only. The co-morbid diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive development disorder or autism, anorexia nervosa, or bulimia nervosa.

Docket Number:

BC591623

Company: Anthem Blue Cross Life and Health Insurance Company

Filing Deadline: July 6, 2020

Class Period: August 18, 2011 to February 4, 2020

Objection Deadline: May 21, 2020

Exclusion Deadline: May 21, 2020

Final Approval Hearing: October 15, 2020

Proof of Purchase:

If you want reimbursement, you must submit proof of payment or proof of amount in collections.

Eligibility:

You may be eligible if
You are a California resident,
You were enrolled in an Anthem non-ERISA PPO health plan,
You had a co-morbid diagnosis (of schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive development disorder or autism, anorexia nervosa, or bulimia nervosa)
During the class period (August 18, 2011 to February 4, 2020), and
Between August 18, 2011 and April 17, 2018, Anthem identified you as likely having a co-morbid diagnosis when you requested authorization of treatment associated with a primary diagnosis of substance abuse, and
During the class period (August 18, 2011 to February 4, 2020), your request for authorization of treatment was reviewed under Anthem’s criteria as to whether it was medically necessary for substance abuse treatment, and
You did not get treatment because (1) Anthem denied your request for authorization of treatment because you’d reached your plan’s limit of thirty days or visits for treatment of substance use, (2) Anthem denied your request for authorization of treatment because they were not medically necessary under Anthem’s criteria for substance use disorders, or (3) you did not seek authorization of treatment because an Anthem representative or provider told you you’d reached your plan’s limit of thirty days or visits for a substance use disorder.

Typical Settlement Amount:

Reimbursement of out-of-pocket or collection amounts for members who fall into one of these damage payment categories: (1) Reprocessing, (2) Continued Treatment, or (3) Discontinued Treatment. Anthem has also agreed to change certain of its practices for determining what is medically necessary. Payments of up to $7,500. For more information, see the Notice and the respective claim forms for each of these categories at the settlement website.

Total Settlement Amount: Unknown

Class Representative Proposed Incentive Fee:

$15,000

Law Firms:
Kantor & Kantor, LLP
Law Offices of Kathryn Trepinski

Claim Form: Anthem Blue Cross Refusal to Pay Settlement Claim Form

Case Name: Ames v. Anthem Blue Cross Life & Health Insurance Company

Settlement Website: Anthem Blue Cross Refusal to Pay Settlement Website

Claims Administrator:
Rust Consulting, Inc.

Claims Administrator Contact Information:

Ames Settlement Administrator
c/o Rust Consulting Inc. – 6861
PO Box 44
Minneapolis, MN 55440-0044
1-866-403-0681

Tags: Denial of Benefits, Health Insurance, Insurance