OCT 12 1994

The Honorable Gary L. Ackerman Member, U.S. House of Representatives 218-14 Northern Boulevard Bayside, New York 11361 Dear Congressman Ackerman: This letter is in response to your inquiry on behalf of your constituent, Dr. Leon J. Cantor of Fresh Meadow, New York. Dr. Cantor has expressed concern over Metlife Empire Plan's decision to deny reimbursement for one of Dr. Cantor's patients, XX . Under the terms of the Americans with Disabilities Act (ADA), insurance offices are places of public accommodation and, as such, may not discriminate on the basis of disability in the sale of insurance contracts or in the terms or conditions of the insurance contracts they offer. Because of the nature of the insurance business, however, consideration of disability in the sale of insurance contracts does not always constitute discrimination. An insurer or other public accommodation may underwrite, classify, or administer risks that are based on or not inconsistent with State law, provided that such practices are not used as subterfuge to evade the purposes of the ADA. Under the ADA, an insurance company may not refuse to insure, or refuse to continue to insure, or limit the amount, extent, or kind of coverage available to an individual, or charge a different rate for the same coverage solely because of a physical or mental impairment, except where the refusal, limitation, or rate differential is based on sound actuarial principles or is related to actual or reasonably anticipated experience. While it is unfortunate that Metlife has refused to reimburse XX for a portion of her treatment, there is no evidence to suggest here that Metlife is violating the Americans with Disabilities Act as it relates to XX insurance coverage.

01-03464 -2I hope the information provided above will assist you in responding to Dr. Cantor's concerns. Sincerely,

Deval L. Patrick Assistant Attorney General Civil Rights Division 01-03465​JULY 26, 1994 METLIFE EMPIRE PLAN GROUP NUMBER 30500 INSURED: SUSAN RALSTON I.D. #: 094 40 9311 DEPENDENT: SELF MAIL NUMBERS: 4052653095 and 4062361506 ATTN: TRISH KAYSER DEAR MS. KAYSER: We are in receipt of your letter dated July 15, 1994, for which the Empire plan of the Metlife has declined reimbursement for the visits of March 23, 30th, April 6th,20th, May 4th and May 11th, for patient XX , who suffers with frequent sore throats. These have been documented by Strep cultures done in this office. XX is not a Strep carrier and she has a child for which she takes care of this child. She is currently under the care of this office for her frequent sore throats and Strep Pharyngitis. In the past she has done very well medically, unfortunately at this time she is not doing well and may need more definative medical benefits in the form of surgery. At this moment she is being treated medically and necessitates follow-up care. We feel that no insurance company should justify what is necessary

or what is unnecessary when a patient participates in a insurance plan. Metlife does not negate the need for XX to see her doctor they negate the need to reimburse her appropriately. My question is: Why should a party partake in a insurance coverage when they are not reimbursed for the necessity of there visits. Nobody should dictate to a patient when, how and how frequently they see a doctor for a diagnosis and for treatment. We feel that all reimbursements to this patient should be forthcoming and we have taken the liberty of sending a copy of this letter to Congressman Ackerman as well as the Governor of the state of New York, awaiting there reply on the behalf of XX . I remain, Sincerely yours,

LEON J. CANTOR,M.D.,P.C. LJC/dr 01-03466