The lawsuit alleged that Anthem improperly denied coverage for residential mental health and substance use disorder treatment

The Kennedy Forum is committed to helping people access the coverage and care they need, and a recent parity-related class-action settlement may offer new options for some individuals. If you were denied residential mental health or substance-use treatment by Anthem between April 29, 2017 and April 30, 2025, you may be eligible for compensation through a settlement involving allegations that Anthem applied medical-necessity criteria that did not align with federal ERISA and Mental Health Parity and Addiction Equity Act (MHPAEA) requirements.

Key deadlines include:

• Claim submission deadline: January 20, 2026
• Deadline to opt out or object: December 19, 2025

How Consumers May Know if They Are Eligible

You may qualify for compensation if:

• The denial occurred between April 29, 2017 and April 30, 2025, and
• You were covered by an ERISA-governed employer-sponsored health plan administered by Anthem, and
• Your request for residential treatment for a mental health or substance use disorder was denied for lack of medical necessity, and
• The denial relied on Anthem’s Clinical UM Guidelines or MCG Guidelines for Residential Behavioral Health Level of Care, and
• The denial was not reversed on appeal.

What Advocates Can Do to Help

Advocates play a critical role in helping consumers understand and access the relief available through this settlement. Consider:

• Encouraging consumers to act early, especially if they plan to submit claims requiring documentation.
• Sharing information with your networks about eligibility and upcoming deadlines.
• Providing guidance to individuals who may need help navigating the claims process.
• Connecting consumers with state-level Consumer Assistance Programs, Departments of Insurance, or other organizations equipped to support parity-related questions.
• Helping individuals identify and gather key documents, which may include denial letters, Explanation of Benefits (EOBs), treatment invoices, and records of out-of-pocket payments.

Stay Connected for Updates

The Kennedy Forum will continue providing updates and resources that help consumers navigate the claims process and understand their parity rights. Sharing this information widely — particularly with communities most affected by coverage denials — can make a meaningful difference. For questions about parity, please contact info@thekennedyforum.org.