1. Why should I read the Notice?
2. What is this lawsuit about?
3. Who is a class member?
4. Did the Court decide who is right?
5. What does the Settlement do?
6. What happens if I do nothing?
7. Why would I ask to be excluded (opt out)?
8. How do I opt out of the Class?
9. If I don’t exclude myself, can I sue for the same thing later?
10. How do I object to the Settlement?
11. Do I have a lawyer in the case?
12. Will the lawyers and Class Representatives be paid, and if so, how?
13. How is the cost of providing notice to Class Members paid for?
14. When and where will the Court decide whether to approve the Settlement?
15. Do I have to come to the hearing?
16. May I speak at the hearing?
17. Are there more details about this Lawsuit?
18. How can I learn more?
19. How do I correcting my mailing address?
The Court has certified a Class in the below-described Lawsuit (see FAQ 2). This Class consists of individuals whose coverage requests for insurance benefits for residential treatment of a mental illness or substance use disorder were denied by Anthem, based upon Anthem’s medical necessity criteria, during certain time periods. The Class is more fully described below (see FAQ 3).
The Notice provides a summary of the Lawsuit and a proposed Settlement. It also describes who is included in the Class, the effect of participating in the proposed Settlement as a Class Member, and how to request exclusion from the class.
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This is a civil lawsuit filed in the United States District Court for the Eastern District of New York. The complaint names as defendants Anthem, Inc. and Anthem UM Services, Inc.
On March 19, 2024, the Court certified the Class and appointed the named Plaintiffs—Marissa Collins, Karyn Sanchez, James Burnett, and A.I. (a pseudonym)—as Class Representatives.
2a. Plaintiffs’ Claims
Plaintiffs assert claims under two federal statutes: ERISA and the Parity Act. Plaintiffs allege that Anthem violated ERISA in two ways: (1) by creating and adopting medical necessity criteria (the “Challenged Guidelines”) for its use in adjudicating claims for insurance benefits for residential treatment of mental illness or substance use disorders, that were more restrictive than generally accepted standards of care and the terms of the Class Members’ health benefit plans, which Plaintiffs claim breached fiduciary duties Anthem owed to the Class Members; and (2) by using the Challenged Guidelines to deny the Class Members’ coverage requests for benefits for residential treatment for mental illness or substance use disorders, which Plaintiffs contend made the denials arbitrary and capricious.
Plaintiffs allege that Anthem violated the Parity Act because the Challenged Guidelines were more restrictive than the medical necessity criteria Anthem used to evaluate comparable services to treat medical and surgical conditions.
2b. Anthem denies liability
Anthem denies any wrongdoing or liability for the claims alleged and asserts that it properly utilized appropriate guidelines to review requests for coverage for residential treatment during the period at issue in this case.
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In an order dated March 19, 2024, the Court certified a Rule 23(b)(2) class defined as follows:
“Any member of a health benefit plan governed by ERISA, the terms of which require that covered services must be provided in accordance with generally accepted standards of medical practice, (a) whose request for coverage of residential treatment services for a behavioral health disorder was denied for lack of medical necessity by Anthem UM Services, Inc. on or after April 29, 2017; where (b) such denial was based on Anthem’s Clinical UM Guidelines or the MCG Guidelines for Residential Behavioral Health Level of Care; and (c) such denial was not reversed on administrative appeal.” |
The Class Period is April 29, 2017, to April 30, 2025.
If you received notice, then Anthem’s records indicate that you sought coverage for residential treatment under a health plan administered by Anthem and that, within the Class Period, Anthem denied your request based on the Challenged Guidelines. Therefore, you are a Class Member unless you opt out.
If you are not sure whether you are a Class Member, you can email or write to the lawyers in this case at the addresses listed in FAQ 10.
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No, the parties entered into the Settlement before the Lawsuit reached a trial or court decision, so if the Court approves the Settlement, there will not be a trial or a decision about which side was right.
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The Settlement has two major parts: (1) payments to Class Members; and (2) a release by Class Members of legal claims arising out of or related to Anthem’s denials of the Class Members’ requests for coverage of residential treatment during the Class Period.
5a. Payments to Class Members
Under the Settlement, Anthem will make a lump sum payment of $12.875 million. This Settlement Amount, after subtracting settlement administration costs, attorneys’ fees and expenses, and any Class Representative incentive award, will make up the “Settlement Fund.” The Settlement Fund will be used to reimburse Class Members for out-of-pocket payments they made for residential treatment services after Anthem denied coverage based on the Challenged Guidelines (a “Qualifying Denial”) and to provide a nominal payment to all other Class Members. A Settlement Administrator who has experience handling cases that involve personal health information will oversee the distribution of payments from the Settlement Fund to Class Members.
The allocation of the Settlement Fund to Class Members (the “Plan of Allocation”) will be as follows:
All Class Members will receive either a pro rata share of the Out-of-Pocket Reimbursement Fund (a "Pro Rata Reimbursement Payment") or a Nominal Payment of at least $100.00.
To receive a Pro Rata Reimbursement Payment, a Class Member must timely submit a Claim Form and Proof of Payment sufficient to establish that they paid out-of-pocket for an episode of residential treatment that began no later than 14 days after a Qualifying Denial (i.e., a "Recognized RTC Treatment Episode"). The maximum number of days of residential treatment that will be eligible for reimbursement from the Out-of-Pocket Reimbursement Fund is 365 days per Recognized RTC Treatment Episode.
A Claim Form and instructions for submitting Proof of Payment was included with the Notice and are available here. To be considered timely, Claim Forms must be submitted online or postmarked no later thanJanuary 20, 2026.
The Settlement Administrator will determine whether each timely Claim Form qualifies for a Pro Rata Reimbursement Payment. Class Members who submitted qualifying claims will share the Out-of-Pocket Reimbursement Fund on a pro ratabasis.
All Class Members who do not receive a Pro Rata Reimbursement Payment will receive a Nominal Payment, which will not be less than $100.00.
The complete Plan of Allocation is available here.
5b. Release of claims Against Anthem
Upon the Effective Date of the Settlement Agreement after final approval by the Court, the Class Members will release Anthem (and related entities) for all legal claims against it arising out of or related to Anthem’s denials of the Class Members’ requests for coverage of residential treatment for lack of medical necessity during the Class Period. The definition of “Released Claims” in the Settlement Agreement is:
“Released Claims” means all claims raised in the Complaints and any and all liabilities, suits, debts, covenants, controversies, promises, judgments, rights, claims, actions, class claims, causes of action, demands, damages, costs, attorneys’ fees, losses, and remedies, whether known or unknown, existing or potential, suspected or unsuspected, liquidated or unliquidated, legal, statutory, or equitable, that were or could have been alleged or asserted in this Litigation, with respect to the Class Members’ requests for benefits for residential treatment services that were denied for lack of medical necessity throughout the Class Period. |
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If you do nothing, you will be included in the Class. You will get at least a Nominal Payment according to the Plan of Allocation described above, and you will have the opportunity to submit a claim for a Pro Rata Reimbursement Payment. And you will be bound by the Settlement if it is finally approved by the Court. If you do nothing, you will not be able to sue Anthem on your own for the Released Claims as described in the part of Question 5.b titled “Release of Claims against Anthem.” If you want to pursue any claim related to the issues in this case on your own and at your own expense, you should opt out of the Settlement.
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You should ask to be excluded if you want to keep your right to pursue your own individual lawsuit against Anthem relating to the issues in this Lawsuit. If you choose to opt out, you will not receive any payment from the Settlement Fund, but you will not be bound by the Settlement either, including the Release of Claims.
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To exclude yourself from the Class, you must do one of the following:
Click here and follow the directions for how to fill out and submit the Opt-Out Form electronically;
Download and print out the Opt-Out Form from here, fill it out and sign it, and send it by first class mail to the Settlement Administrator at: Collins, et al. v. Anthem, Inc. Settlement Administrator, c/o Simpluris, P.O. Box 25226, Santa Ana, CA 92799;
Email the completed and signed Opt-Out Form to the Settlement Administrator at info@Anthem-RTC-Criteria-Settlement.com; or
Mail or email to the Settlement Administrator a request for exclusion that includes your full name (and business name, if applicable), mailing address, telephone number, email address, signature (or an electronic signature consisting of "/s/" plus your typed name), and the following statement: "I request that I be excluded from the Class in Collins, et al. v. Anthem, No. 2:20-cv-01969-FB-SIL (E.D.N.Y)." An opt-out request that does not clearly state you wish to be excluded—or that makes conflicting requests to be excluded and to receive money from the Settlement—will not be treated as a valid opt-out.
Requests for Exclusion that are not postmarked on or before December 19, 2025, or are not submitted electronically on or before 11:59 p.m. Eastern Time on December 19, 2025, will not be honored.
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No. If the Court approves the Settlement and you do not opt-out by the deadline, you will be subject to the release of claims described in FAQ 5.b above and will lose your right to sue Anthem individually for relief arising from the Released Claims. You will receive a monetary payment from the Settlement only if you do not exclude yourself.
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You can object to the Settlement, the proposed Plan of Allocation, the attorneys’ fees and expenses requested, or the Class Representative incentive awards. Submitting an objection gives you the chance to tell the Court why you think the Court should not approve any of these things, but it will not exclude you from the Settlement.
To object, you must send the Court a letter via first class mail stating why you object to the Settlement, and include (i) your name, address, telephone number, and signature; (ii) the number of times you have objected to a class action settlement within the five years preceding the date that you file the objection; (iii) the caption of each case in which you have made such objection; (iv) a copy of any orders related to or ruling upon your prior such objections that were issued by the trial and appellate courts in each listed case; (v) the identity of all counsel who represent you; and (vi) a statement indicating whether you intend to personally appear and/or testify at the Court’s Final Approval Hearing and the identity of all counsel representing you who will appear at the Final Approval Hearing.
You must mail the objection to the Court, Anthem’s Counsel, and Class Counsel at the addresses below, so that they are received no later than December 19, 2025:
Court | Anthem’s Counsel |
Clerk of the Court | Rebecca R. Hanson |
Class Counsel | ||
Caroline E. Reynolds | Meiram Bendat | Julie Selesnick |
Objections that are not received by the court on or before December 19, 2025, will not be honored.
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Yes, unless you exclude yourself from the Class. The Court decided that Caroline E. Reynoldsand Jason Cowart of Zuckerman Spaeder LLP; Meiram Bendat of Psych Appeal, Inc.; and Julie Selesnick of Berger Montague are qualified to represent the members of the Class. Together, the lawyers are called “Class Counsel.”
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The Settlement Agreement allows Class Counsel to ask the Court to approve payment of attorneys’ fees in an amount up to 33.3% of the Settlement Amount, plus the expenses Class Counsel incurred during the case. Thus, the maximum amount in attorneys’ fees from the Settlement is $4,291,237.50. This payment, plus reimbursement of litigation expenses, will compensate Class Counsel for their work investigating the facts, litigating the case, and negotiating the Settlement. The Court must approve the amount of fees and expenses awarded to Class Counsel. Class Counsel will file a motion requesting attorneys’ fees and litigation costs no later than November 28, 2025, so you will have time to review that motion prior to deciding whether you want to object or opt-out.
The amount that the Class Representatives (who brought the lawsuit and who have served as the named Plaintiffs) receive from the Settlement Fund will be determined by the same Plan of Allocation used for all Class Members. In addition, the Settlement Agreement allows Class Counsel to ask the Court for an “incentive” award of up to $10,000.00 for each Class Representative. That motion will be filed no later than November 28, 2025. Any incentive award must be approved by the Court.
Class Counsel’s motion for attorneys’ fees and expenses and an incentive award to the Class Representatives will be available online on this website, or you can contact the Settlement Administrator.
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The costs of providing notice about the Settlement to Class Members will come out of the Settlement Amount.
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The Court will hold a Fairness Hearing on January 26, 2026, at 11:00 a.m., at the United States District Court for the Eastern District of New York, 225 Cadman Plaza East, Brooklyn, NY 11201. At this hearing the Court will consider whether the Settlement is fair, reasonable, and adequate. If there are objections, the Court will consider them. The judge in the case, Judge Steven I. Locke, will listen to people who have asked in advance to speak at the hearing. The Court may also decide how much Class Counsel may receive in attorneys’ fees and expenses, and how much the Class Representatives should receive as incentive awards. After the hearing, the Court will decide whether to approve the Settlement. It is not known how long these decisions will take.
The Court can change the date of the hearing without further notice, so please check the docket for the case if you want to appear to make sure that the date and time have not changed.
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No. Class Counsel will answer questions the Court may have. But you are welcome to come at your own expense. If you send an objection, you don’t have to come to Court to talk about it. As long as you mailed your written objection on time, the Court will consider it. If you retain your own lawyer, your lawyer can attend on your behalf.
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Yes. You (through your attorney if you have one) will need to notify the Court of your intention to personally appear and/or testify at the Fairness Hearing and the identity of all counsel representing you who will appear at the Fairness Hearing, in the manner described above in response to FAQ 10. You cannot speak at the hearing if you opted out of the Settlement.
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Yes. Additional information regarding the Lawsuit and the Settlement is available on the Important Documents page. The information includes the complaint filed in the case, the Settlement Agreement and its attachments, the Opt-Out Form and Claim Form, the proposed Plan of Allocation, and the motion for preliminary approval of the Settlement, along with the exhibits to the motion. In addition, the motion for attorneys’ fees and expenses and an incentive award to the Class Representatives will be posted to this website after it is filed on or before November 28, 2025.
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Any questions you have concerning the matters contained in this website and the Notice should be directed to Plaintiffs’ Counsel or the Settlement Administrator. Do not call the Court or Anthem (which is now Elevance Health, Inc.).
This website and the Notice, does not fully describe all of the claims and contentions of the parties. The pleadings and other papers filed in this Lawsuit are available for inspection during business hours at the United States District Court for the Eastern District of New York, 225 Cadman Plaza East, Brooklyn, NY 11201.
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If notice was sent to your correct mailing address, you do not have to do anything to receive further notices concerning this litigation. If notice was forwarded by the postal service, if it was sent to an individual or address that is not correct or current, or you need to update your mailing address after claim filing, you should immediately contact the Settlement Administrator at the following:
Collins, et al. v. Anthem, Inc.
c/o Settlement Administrator
P.O. Box 25226
Santa Ana, CA 92799
info@Anthem-RTC-Criteria-Settlement.com
Do not contact the Court or Clerk of Court regarding this Settlement.
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