Anthem Sued Over Residential Mental Health Treatment Coverage

Anthem Inc. is accused of denying coverage for residential mental health treatments by using overly restrictive guidelines for determining medical necessity, according to a proposed class action filed in the Eastern District of New York.

The lawsuit, filed Wednesday by Anthem plan participants Marissa Collins and James Burnett, says Anthem’s internal guidelines for deciding when to cover residential mental health treatments are out-of-step with the medical community. They focus too much on “short-term crisis intervention” while minimizing the importance of chronic and persistent symptoms that can’t be treated effectively with short-term care, they say.

Collins and Burnett say Anthem’s conduct ...