Anthem Blue Cross Eating Disorder Coverage Settlement Approved

A class settlement requiring Anthem Blue Cross to reprocess certain claims for eating disorder treatments or pay up to $5,500 for denied claims received final approval in California federal court, as did an attorneys’ fee award of nearly $1 million.

The deal, which applies to as many as 2,281 California residents covered by Anthem-administered health plans, allows class members to resubmit their claims for eating disorder treatment so they can be reprocessed under more expansive medical necessity criteria, up to a $400,000 cap for all claims. Alternatively, class members can opt to receive a set payment of $5,500 or $2,100, depending on whether they continued treatment after denial.

Judge Jeffrey S. White of the US District Court for the Northern District of California signed the final approval order Tuesday. In a separate order, White awarded class counsel $993,918 in attorneys’ fees and costs.

The lawsuit accused Anthem of wrongly refusing to cover residential eating disorder treatments by relying on medical necessity criteria that were at odds with generally accepted standards of medical practice.

White previously dismissed one of the named plaintiffs from the action but allowed the case to move forward based on the claims of an 18-year-old woman whose anorexia treatments allegedly cost more than $100,000.

Kantor & Kantor LLP and Kathryn Trepinski of Beverly Hills, Calif., represent the class. Morgan, Lewis & Bockius LLP represents Anthem.

The case is Bailey v. Anthem Blue Cross Life & Health Ins. Co., N.D. Cal., No. 4:16-cv-04439, settlement approval order 5/24/22.