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 01-03454

-2call 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 01-03455

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 01-03457 2