Law360 (April 30, 2020, 7:39 PM EDT)
— Two participants in employee health plans run by Anthem slapped the company with a class action lawsuit in New York federal court Wednesday, accusing the insurer of relying on improperly strict internal guidelines when deciding whether to cover residential mental health treatment.
Marissa Collins and James Burnett say that Anthem Inc.’s guidelines violate the Employee Retirement Income Security Act, which requires employee benefit plans to cover mental health treatment in a similar manner to medical treatment.
“For years, Anthem has knowingly used flawed criteria to make coverage determinations for residential treatment of mental health conditions,” said an attorney for Collins and Burnett, D. Brian Hufford of Zuckerman Spaeder LLP, in a statement Thursday. “The criteria not only fall below accepted medical standards and violate … ERISA, they also contradict the written terms of Anthem’s plans.”