Anthem agreed to settle a class action from participants in employee health plans the insurer administered who alleged that coverage denials for inpatient mental health and substance use disorder treatments violated federal benefits and mental health parity laws, the parties told a New York federal court Tuesday.
The plaintiffs allege Anthem violated the Mental Health Parity and Addiction Equity Act of 2008 by applying overly restrictive criteria for processing mental health and substance use disorder treatment claims that were incompatible with medical-necessity criteria within participants’ ERISA-regulated plans. The Parity Act requires that health plans’ limitations on behavioral health treatment can’t be more restrictive than what’s applied in the medical and surgical context.
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