Facts

Plaintiff Robin Goolsby filed a class action lawsuit on behalf of herself and others, against Defendants Anthem, Inc. and Anthem UM Services, Inc. Defendant Anthem was one of the largest health care companies that owned subsidiaries, including Anthem UM Services, which acted as a fully integrated company that insured and administered Health Care Plans. Most of the administered Heath Care Plans were employer sponsored and governed by the authority of the Employee Retirement Income Security Act of 1974, also known as ERISA. Plaintiff alleged that Defendants improperly denied claims for surgical treatment of lipedema made by Anthem members.

PLAINTIFF'S CONTENTIONS: Plaintiff contended at all relevant times she was covered under Anthem through her employer Verizon, and when she was diagnosed with stage 3 lipedema, Defendant refused to provide treatment for tumescent liposuction and other related dealings that would have treated Plaintiff's stage 3 lipedema. Plaintiff contended surgical treatment of Lipedema was not considered an optional cosmetic surgery, rather it was a required and mandated procedure covered under the policy to help improve the covered members health.

DEFENDANTS' CONTENTIONS: Defendants denied Plaintiff's contentions and contended surgical treatment of lipedema was considered cosmetic surgery and thus not covered or mandated under the health insurance policy.

Result

The parties entered into a settlement agreement which included a change in Anthem's coverage position on claims for liposuction to treat lipedema, provided for the re-processing of previously denied claims under a new guideline, and required Anthem to pay $434,500.00 in attorney fees and costs.