It’s Time to Take a Stand

It went out in the mail today. The letter I wrote, all 9 pages of it. I sent it to the Maryland delegation to Congress: Senators Mikulski and Cardin; Representatives Harris, Sarbanes, Ruppersberger, Edwards, Hoyer, Delaney, Cummings and Van Hollen; Maryland’s Governor and Lt. Governor; the Governor’s Chief Legislative Officer (Joe Getty); and the Maryland General Assembly leadership: Miller, Pugh, Gladden, Raskin, Jennings, Hershey, Ready, Busch, Kaiser, Talmadge, Kipke and Szeliga; and my local Delegates: Krebs, Rose and Shoemaker. 28 in all. I sent it. It had to be said and it must be changed. Here is what I sent them. Post this everywhere.  Make it go viral.  Too many suffer in silence and can’t speak for themselves.  Let’s get it out to ALL Senators, Representatives and State level leadership.  IT’S TIME TO TAKE A STAND!!

Honorable Ladies and Gentlemen:

I am writing to bring a situation to your attention that needs to be legislatively rectified. I believe that after you understand the realities of the circumstances it will be clear to you then why legislative action MUST be taken. A large segment of the population of the United States and State of Maryland are suffering discrimination and it MUST stop.

For context, let me provide you with some information about myself. I am and have been a Maryland resident most of my life. I was born here and was raised mostly in Carroll County. I have been married for 23 years and I have raised my two children, ages 21 and 17 in Carroll County. I am employed full time as a Paralegal for the legal department of a franchise company and have been employed there for over 9 years. I’ve worked as a paralegal in various settings for more than 20 years. I have an Associate’s Degree from Villa Julie College in Paralegal Studies (1991, magna cum laude) and a Bachelor’s of Science Degree from Stevenson University in Paralegal Studies (2010, summa cum laude, inducted into Lambda Epsilon Chi and Alpha Chi honor societies).

My situation specifically deals with Aflac Incorporated (“AFLAC”), but I am advised that all disability insurers have similar, if not identical, policy exclusions regarding coverage for the mentally ill.

An outline of the steps I have taken are enumerated below. I have enclosed my initial letter to AFLAC, together with supporting documentation, my complaint to the Maryland Insurance Administration, together with supporting documentation, along with their response and supporting documentation (Note, the supporting documentation isn’t attached, but may be posted at a later date).

In May of 2014 I purchased three policies from AFLAC through my employer. The policies were effective June 1, 2014:

  1. Short Term Disability policy number (redacted). This policy was paid from after tax income, and deducted from my paycheck.
  2. Specified Event policy number (redacted). This policy is paid from pre-tax income and deducted from my paycheck.
  3. Accident policy number (redacted). This policy is paid from pre-tax income and deducted from my paycheck.

When the opportunity to purchase policies through AFLAC was presented to my company, the agent never mentioned any specific exclusions to coverage. To be fair, no one asked about exclusions either, but who would in a group setting given the shame surrounding mental illness? Television advertising for AFLAC policies also do not mention any specific, across the board, exclusions to their policies. I have, since this situation came to a head, frozen my TV screen when small print comes up in their advertising and there is no specific mention of policy exclusions.

My premiums were paid each month, timely and in full. There were no claims against any of the policies during the entire policy period.

On May 18, 2015 I was hospitalized for 9 days (through May 26, 2015) and was diagnosed with Major Depressive Disorder, severe and recurring. After I was discharged I called AFLAC to seek assistance with a claim against the short term disability policy and the specified event policy. After providing the customer service representative with the reason for my hospitalization, I was advised that AFLAC didn’t provide any coverages for mental illness. It was, she explained, an exclusion that applied to every policy they write. Since I was unable to file a claim, I ended the conversation.

After a month in an intensive outpatient program (“IOP”), I was discharged On June 27, 2015 from hospital care and entered private, weekly therapy. Costs for my hospitalization, despite having health insurance, are running in the tens of thousands of dollars. I have been in private therapy and will be for the foreseeable future. At present I am attempting to juggle paying the hospital in patient stay, emergency room doctor, IOP program, psychiatry and prescription bills, along with my outpatient therapy expenses. Having had coverage for the hospitalization and IOP program under the Specified Event policy and time missed from my employment under the Short Term Disability policy would have been a huge help.

On or about July 8, 2015 I wrote to AFLAC’s Chairman and CEO, Daniel P. Amos, and President, Paul S. Amos, II. A copy of said letter is enclosed as Exhibit 1. In it I laid out the above facts, and my assertions that denial of coverage to the mentally ill is per se discrimination.

On or about July 21, 2015, I received correspondence from the Felicia Sweat in the AFLAC Claims Department, dated July 17, 2015. A copy is enclosed as Exhibit 2. Her letter states that they were investigating my “claim” and would get back to me. Keep in mind I never filed a claim. I was complaining about their discriminatory practices. After my first phone call to AFLAC, I have never expected any recovery under my policies.

On or about July 31, 2015, I received a second piece of correspondence from Ms. Sweat dated July 27, 2015. A copy of this correspondence is enclosed as Exhibit 3. In it, she explained in detail the exclusion to all of their policies. Though she just said it was excluded from my three, I knew from my telephone conversation on May 27th that they exclude mental health coverage from every policy they write. She also offered, “as an exception” to allow me to cancel my short term policy, retroactive to June 1, 2014, and refund my premiums paid from June 1, 2014 to the present. While I appreciate the gesture, it didn’t address the “meat” of my complaint – discriminatory practices. To date, neither Daniel Amos nor Paul Amos has responded directly to my questions or allegations.

On August 13, 2015 at 11:44 am I faxed a letter cancelling the short term policy. A copy of the letter and fax completion report are enclosed as Exhibit 4. On September 15, 2015 I received a check from AFLAC for my cancellation of the short term disability policy (also enclosed as part of Exhibit 4).

On September 16, 2015 I sent a letter of complaint to the Maryland Insurance Administration (“MIA”) regarding the discriminatory practices of AFLAC. I requested that they look into the practices and make any necessary changes to the rules to close this loophole. A copy of the complaint letter is enclosed as Exhibit 5.

The MIA responded to my September 16, 2015 letter on November 5, 2015. A copy of their response is enclosed as Exhibit 6. In their response, they advised that they cannot require AFLAC to cover mental illness under their policies due to Maryland law allowing the loopholes. Specifically, they advised: “We reviewed Maryland insurance laws. Maryland implemented a state law that mirrors the federal law that requires parity for mental health…This law applies to individual and group health benefit plans… the company (AFLAC) has confirmed that it does not sell health benefit plans, as defined in the above laws. This means the policies do not have to comply with the state mental health parity law.” They then suggested that I discuss it with my legislators.

Part of Exhibit 6 is the response to my MIA complaint from AFLAC. They allege that “Maryland Insurance Code section 15·802 (e)(1)(ii)…requires benefits for the actual treatment of the illness. It does not state that a supplemental insurance carrier must provide benefits for loss of income, which is the purpose of short·term disability coverage.” and that “a ‘health benefit plan’ is defined under Maryland Insurance Code section 15·1401 0)(2), and…does not include: (i) one or more, or any combination of the following: 1. coverage only for accident or disability income insurance”. I would argue that the Specified Event Policy, which provides specific monetary amounts for different types of illnesses or injuries, is not an “accident or disability insurance” but instead an insurance policy for the illness or injury, not for loss of income. In any case, the exclusion from any policy, disability or otherwise is per se discrimination.

As I said, I have never, beyond my initial phone call, made any demands for coverage because I acknowledge there is an exclusion on each policy. The whole point to that letter, the complaint to the MIA, and this one, is that the exclusion itself, and the laws permitting it, are discriminatory.

Not covering mental illness on any policy they write should be illegal, whether under the American’s with Disabilities Act (“ADA”) or existing parity laws. As I outlined on pages 2 and 3 of my July 8, 2015 letter, the ADA includes “mental impairment” under its definitions of a disability. I further quoted verbatim sections of the ADA (the full text of which can be accessed here) as it pertained to discrimination against the mentally ill. If the ADA specifically excludes disability coverage, something I couldn’t find when reading the entire Act, it should be amended to change that. Logically it doesn’t because it specifically includes mental illness as a defined disability.

In fact, the ADA includes the very same mental health diagnoses that the July 27th AFLAC letter specifically excluded: “Mental or emotional disorders, including but not limited to the following: bipolar affective disorder (manic-depressive syndrome), delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, depression, stress, or post-partum depression.”

Almost all companies, employers, housing authorities and so forth are prohibited under the ADA from discriminating against the mentally ill. Parity laws on a federal and state level also prohibit health insurers from providing disparate coverage, from capping, minimizing and/or refusing to cover mental health treatment. Parity laws legally recognizing mental health conditions and substance abuse as equal to physical illnesses. About half of all Americans who are covered by health insurance are enrolled in large self-insured health insurance plans that are subject to federal parity. Federal parity replaces state law only in cases where the state law provides for less parity than federal law, but if a state law is stronger, it applies in place of the federal law. (More info. can be found here.) 

I realize that AFLAC is not a health insurance company. It’s a disability insurance company. However, I see no logical reason why their policies, which provide coverage when your health is in question, should be held to a different standard.

My question, and one you should be asking yourself, is why do disability insurance providers exclude mental health coverage and why are they allowed to violate the ADA definitions and federal and/or state parity laws and discriminate against the mentally ill? The answer, of course to the first part is that it is fiscally advantageous to refuse to cover it. The answer to the second part is that legislators like yourselves have either not addressed the issue or have been influenced by those same disability insurers to allow them to discriminate. Neither are a valid excuse to do so.

As I stated in my first paragraph, this allowable discrimination affects millions of Americans. The National Alliance on Mental Illness (“NAMI”) provided the following statistics:

  • Approximately 1 in 5 adults in the U.S., that’s 43.8 million, or 18.5%, experiences mental illness in a given year.
  • Approximately 1 in 25 adults in the U.S., 10 million, or 4.2%, experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.
  • Approximately 1 in 5 youth aged 13–18, 21.4%, experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.
  • 1.1% of adults in the U.S. live with schizophrenia.
  • 2.6% of adults in the U.S. live with bipolar disorder.
  • 6.9% of adults in the U.S., 16 million, had at least one major depressive episode in the past year.
  • 18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
  • Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%, 10.2 million adults, had a co-occurring mental illness. It makes sense as they were most likely self-medicating.
  • An estimated 26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders.
  • Approximately 20% of state prisoners and 21% of local jail prisoners have “a recent history” of a mental health condition.
  • 70% of youth in juvenile justice systems have at least one mental health condition and at least 20% live with a serious mental illness.
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year.
  • Just over half (50.6%) of children aged 8-15 received mental health services in the previous year.
  • African Americans and Hispanic Americans used mental health services at about one-half the rate of Caucasian Americans in the past year and Asian Americans at about one-third the rate.
  • Half of all chronic mental illness begins by age 14; three-quarters by age 24. Despite effective treatment, there are long delays, sometimes decades, between the first appearance of symptoms and when people get help. This is exactly my situation. I most likely had onset of depression at or around the age of twelve. I didn’t seek regular treatment until recently.
  • Serious mental illness costs America $193.2 billion in lost earnings per year.
  • Mood disorders, including major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.
  • Individuals living with serious mental illness face an increased risk of having chronic medical conditions. Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.
  • Over one-third (37%) of students with a mental health condition age 14¬–21 and older who are served by special education drop out, which is the highest dropout rate of any disability group.
  • Suicide is the 10th leading cause of death in the U.S., the 3rd leading cause of death for people aged 10–24 and the 2nd leading cause of death for people aged 15–24.
  • More than 90% of children who die by suicide have a mental health condition.
  • Each day an estimated 18-22 veterans die by suicide.

One of the effects of this discrimination is the feeling of shame, embarrassment and stigma. The stigma only grows, and gains acceptance in society, when companies like AFLAC are allowed to continue to offer disparate coverage. It can only be banished when they are held to the same standards as every other part of society and not allowed to discriminate.

Mental illness is a disease of the brain. It’s absolutely no different than a patient suffering from heart disease, cancer, or some other form of physical illness. The medical field has proven over and over again that these disorders aren’t something that a patient “asks for” or can control onset, any more than they could cancer or heart disease. In fact, cancer and heart disease are more preventable than mental illness. Mental illness isn’t chosen or self-inflicted. They would cover a broken bone caused by falling from a skateboard, or skiing, both activities that involve physical risk and are undertaken voluntarily. They regularly cover heart attacks, strokes and cancer, some of which could be avoided by different lifestyle choices, such as healthier diet and more exercise. No one purposefully “asks for” mental illness. Society recognizes that it’s wrong to stigmatize other illnesses, yet it is perfectly acceptable to stigmatize mental illness.

Treating those with mental illness as people to be feared, pitied, or as those who should be legally humiliated because of their illness is wrong. The recent discussions about the Second Amendment and mental illness speak volumes about the attitude of the general public regarding those who suffer from it. All that stigma makes seeking treatment taboo. Withholding coverage makes it financially difficult or impossible for the patient. It’s been allowed to go on for much longer than it should, despite legal efforts to the contrary.

Speaking from my own experience, the embarrassment of being hospitalized, the shame at not being able to “control” my illness, “listen to reason” and just “get happy” or “snap out of it”, the worry that people will think less of me… kept me from seeking treatment for decades. I am an educated, intelligent woman with health insurance. Yet I am struggling with depression, overwhelming medical costs and the societal stigma that won’t go away. Mental illness shows no discrimination – it cares not that one is educated, insured, old, young, poor, homeless or military. That AFLAC and other similar insurers are allowed to perpetuate stigma by refusing to provide coverage for mental illness as the physical disability it is shameful. It should not be allowed to stand.

I am requesting that you, elected legislators, review Maryland State law, federal parity laws and the ADA and put in place new laws or amend existing laws to prohibit disability insurers from discriminating against the mentally ill. Not all of you represent me specifically, though some do, but I can guarantee that you do represent tens of thousands of voters who struggle as I do. You each owe them, and me, your consideration.

I am available to answer any questions or offer any further information. Thank you for your time and attention, and I look forward to hearing from each of you regarding the steps you will take to rectify this situation.

If you agree with me, send this to everyone you know, including your lawmakers.  Today is the day we ALL take a stand.

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