OCT 4 1994

The Honorable Gary L. Ackerman

Member, U.S. House of Representatives
218-14 Northern Boulevard
Bayside, New York 11361

Dear Congressman Ackerman:

I am responding to your inquiry on behalf of your

constituent, XX regarding his rights under the
Americans with Disabilities Act (ADA).

XX states that he has chronic bipolar mood disorder.

He indicates that his insurance company does not provide adequate
coverage for chronic mental health conditions. The company has
apparently denied some of his benefit claims and has advised him
that he has already received the maximum yearly benefits for
mental health care.

Section 501(c) of the ADA permits insurance practices that

are based on or consistent with State law so long as they are not
used as a subterfuge to evade the purposes of the Act. Most
State laws permit companies to afford lower benefits for mental
health conditions than physical health conditions. In construing
another Federal statute that prohibits discrimination on the
basis of disability, Section 504 of the Rehabilitation Act, the
courts have held that it is not discriminatory to provide lower
benefits for mental health conditions as compared to physical
health conditions. See, e.g., Doe v. Colautti, 592 F.2d 704
(3d Cir. 1979). Doe v. Devine, 545 F. Supp. 576 (D.D.C. 1982),
aff'd on other grounds, 703 F.2d 1319 (D.C. Cir. 1983).

I hope this information is useful to you in responding to

your constituent. If he has further questions, he may wish to

cc: Records; Chrono; Wodatch; Magagna; McDowney; MAF; FOIA

udd\magagna\congress\ackerman

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call our ADA information line at 1-800-514-0301 between 11:00

a.m. and 6:00 p.m. Monday, Tuesday, Wednesday, Friday, and
between 1:00 p.m. and 6:00 p.m. Thursday.

Sincerely,

Deval L. Patrick
Assistant Attorney General
Civil Rights Division
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 XX
XX
Port Washington, NY XX
XX

15 July 1994

Hon. Gary L. Ackerman

Member of Congress
229 Main Street
Huntington, NY 11743

Dear Representative Ackerman:

It has been three months since my last correspondence. Not because there is
any less urgency, import or concern, not by choice, but because I have been
ill. Ill with a life threatening disease of the brain. Ill with a chronic,
potentially fatal disease. Symptoms include lethargy, fatigue, physical
deterioration, difficulty concentrating and remembering, impediments to
productivity, inability to complete tasks, chronic pain, sleep disturbance,
and financial ruin. I have become disabled, no longer able to perform major
life activities including fine motor skill manual tasks, continuing
education, caring for myself, and pursuit of my profession at a pre-morbid
level. I require daily medication, and regular examinations and treatments by
my specialty physician. I have experienced first hand the discriminatory
effects of economic health care rationing. Now I am better. I can maintain a
productive life at a high level of functioning given the proper treatment.
But I fear a relapse, the natural history of my disease if left untreated,
because my insurance company refuses to pay for medically necessary
continuing care. My disease is a chronic, occasional remitting but
unrelenting condition. Symptoms are present 24 hours a day, 365 days a year
yet my managed care entity claims "my benefits have run out". The pain and
agony are intense. The economic costs are devastating. The response is
probably illegal. XX

So now we have XX as patient, who supposedly has the knowledge, skills,

experience and resources to "manage" a "managed-care system". Yet it appears
all for naught. Empire Mental Health Choice (EMHC) and Empire Blue Cross/Blue
Shield want to deprive me of my livelihood, deny me the care necessary to
maintain my health. If I don't get insurance coverage, I can no longer afford
medically necessary therapy. Without proper treatment the possibility of a
severe relapse is great with danger to my physical health, psychological
well-being, health and safety of my family, and economic well-being. My
patients may suffer as well.
1
01-03456

XX
XX
Port Washington, NY XX
XX
Add to this the stigmatization of my illness, chronic bipolar mood disorder

otherwise known as manic-depressive illness and it is not a pretty sight. On

top of the meddling micromanagement by nameless faceless 1-800 factotums who
never take responsibility or care for patients there is the unconscionable
limits on mental health care. The general arguments concerning mental health
care are beyond the present scope. For my disease, indeed for any major mood
disorder there is no question of the biological basis and need for parity in
care with all chronic illnesses. Depression kills more people than heart
attacks. As always, prevention is truly cost effective when viewed against the
staggering cost of untreated illness.

So what to do? On the national level, mental health services must be included
in the basic package of benefits of any health care reform. Please inform me
as to what the provision of the American Health Security Act (H.R. 1200) are
in this regard. Second, the Americans with Disabilities Act is a federal
statute that can and should be construed to serve as an important safeguard
against discriminatory effects of health care rationing. EMHC is a
prototypical self-aggrandizing managed care entity, operating under a cloud
of secrecy, disinformation duplicity and deceit. Representatives and
employees of EMHC and Empire BC/BS have repeatedly misinformed me
concerning
my contract and its benefits. The sanctimonious, oft-quoted platitude; "With
this payment the patient has received the maximum benefits for this type of
care in this calendar year" is unfairly restrictive. It belies any knowledge
of the well documented biological basis of bipolar disease, its chronicity
and tendency for recurrence as well as the proven effectiveness of combined
pharmacologic and psychotherapeutic treatment. People with chronic illnesses
need more health care. The response is probably illegal as well. I am asking
you to please investigate as to whether EMHC and Empire BC/BS are guilty of
violations of the Americans with Disabilities Act, and to proceed accordingly.

Thank you again for your time and concern.

Cordially,
XX
XX

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