Filed under: Affordable Care Act, BenefitsPro, Broker Innovation Lab, Combs & Company, Combs & Company Blog, Health Insurance, Insurance Women, Mental Health, Pancakes for Roger, Susan L Combs, Women in Insurance, Women's Health | Tags: Addiction, Breaking Point, Broker Innovation Lab, Combs & Company, Family, Mental Health, Susan L Combs
By Susan L Combs | October 04, 2023 at 07:19 AM
Original Article on BenefitsPro

I’ve struggled with even starting this article, but this topic has been weighing on my mind for well over a year. In our industry, we talk so much about mental health and wellness, which is great. And as those of us in the industry know, under the Affordable Care Act (ACA), we now have Mental Health Parity. And in some places like New York, even before the ACA we had things like Timothy’s Law that gave New Yorkers access to unlimited mental health sessions in network years prior. This is all incredible.
But you know what we haven’t talked about?
The family of the mentally ill or person struggling with addiction. The people who are showing up as caregivers time and time again only to have their hearts broken for the umpteenth time.
I know I live a pretty open life and many of you reading this probably know that I have been sober for over two decades. I’ve chosen a path for myself that has led me to have an incredible life, and I am grateful that I learned at an early age what a degree from the School of Hard Knocks had to offer by making some pretty big mistakes for myself prior to the age of 23. But I know I put my family through a lot and I own it. I have gone on to make my amends and mend the fences that were damaged but not broken. I have worked hard to try and make the right choice each day for myself and others. Of course, this doesn’t mean I’m perfect or that I don’t blunder and step in it from time to time.
I’m not a big one for having regrets, because I truly feel that you are denying yourself your place in the world right now when you say you have them. I choose to not regret the things I have done because I know that they shaped me as the person I am today and as a result, I have been able to help others. But I broke my parents’ hearts. I made the General cry…
Until recently, I don’t think I realized what it was like being in my parents’ shoes. Dealing with someone who is being irrational when you are trying to be logical can be the definition of frustrating. But about a year and a half ago, I got a major life lesson that I didn’t want and certainly didn’t need. This all comes back to a promise I made to my dad before he passed. My dad and I were “Team Type A” in our family, and I knew that when he was dying, he needed to take comfort in knowing that everything would be OK within our family unit. I promised my dad that “I got this” and that I’d look after my mom and my brothers. The year before my dad passed, “Team Type A” got together and we spreadsheeted, we had all the information organized, I knew who to call if a pipe burst in our little apartment building, I knew who to call to sell the Winnebago, I knew who to talk to about VA benefits that passed to my mom, I had all the passwords, we had everything mapped out. But we didn’t talk about my oldest brother, who has dealt with severe mental illness for well over three decades. We just missed it.
Eighteen months ago, I had my ass handed to me. I had never dealt with a mentally ill person who had gone off their meds. It’s uncomfortable; it’s hard. Everything logical doesn’t work. It reminded me about being around someone who is highly intoxicated, which as a sober person, feels unsafe. It was triggering. He ended up getting arrested and then things really got tough. I’m in NYC, he’s in Kansas; there is so much I can do from here….but I promised my dad. This was a dance I had to make up as I went along. A legal eviction led us to have to purchase a home for him to live in, because no rentals would take him with a felony record, a legal eviction, and other charges. I lost a lot of sleep, but ultimately, I felt that I “fixed” the problem, because I am nothing if not tenacious and can basically figure out any problem you give me. But you can’t fix mental illness. You can’t throw money at it and hope it goes away. You can’t pray it away. You can’t act like it doesn’t exist. Because guess what? When you think things are fine, when you start sleeping soundly and things feel back to normal, it breaks again. And it did. It broke again a few months ago, which led to an involuntary commitment into a state hospital. I don’t think it’s necessary to give you a play by play of what happened, but when death threats are happening and you are being told by your brother that he, “Just got off the phone with Dad” (our father passed away in 2018) it’s rough. It makes you want to run away from the situation and never look back.
But I promised.But what did I promise? Did I promise I would put my own health on the line at the sacrifice of someone else? No. Did I promise I would be a horrible boss and a shit wife because I didn’t have the capacity to show up in the world for the people who depend on me? No. Did I promise to put so much stress on myself that I would have chronic diarrhea for 6 weeks straight because I carry my stress in my stomach? No. Would my father want me to work so hard at fixing an unfixable problem for someone who doesn’t put the work in for themselves? Absolutely not. But I did and I have.
When is it time to walk away?
When is it time to put your own mental health and wellbeing first?
I honestly can’t answer those questions for you, because I’m still figuring that out for myself. But I can tell you what I have done. I have shared about it in my 12-step program, I have shared about it with my therapist, and I’ve shared about it with my tight crew. But you know where I’ve gotten the most support? Just like there is a “Dead Dad’s Club” that you never know about until you are indoctrinated into it, there is the “Mental Illness Family Club” and those are the people who have really helped during this time. Those who have it in their families know how hard it can be. How thankless it can be. How “I’ll never get an apology” it can be. How unaccountable it can be. How abusive it can be. To my Superman fans, it’s what I picture Bizarro World to be. And it sucks.
This article isn’t meant to be a “poor me” piece; like I said before, I have a big beautiful life and I was given so many tools and lessons in my life that have prepared me for this … kinda. This article is meant to see the unseen. For those of you who are in this boat, please know that you aren’t alone. I encourage you to share your stories and find support where you can get it. It’s up to you what that looks like.
Don’t ever apologize for putting your wellbeing first when someone is making you the price of admission.
Be brave.
The Affordable Care Act (ACA or health care reform law) requires nongrandfathered health plans to cover evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) department of HHS.
In guidelines released August 1, 2011, HHS outlined required preventive care services for women. The guidelines require nongrandfathered individual and group health plans to include these services without cost sharing:
- Well-woman visits
- Screening for gestational diabetes
- Testing for human papillomavirus (HPV)
- Counseling for sexually transmitted infections
- Screening and counseling for human immunodeficiency virus (HIV)
- FDA-approved contraception methods and contraceptive counseling
- Breastfeeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
For group health plans (whether insured or ASO), these services must be provided at the first plan year on or after August 1, 2012. For individual plans, the services must be provided in new policies beginning on or after August 1, 2012, and existing policies beginning at the start of the next policy year following August 1, 2012 (generally January 1, 2013). System and market considerations may accelerate the effective date in the individual market in some states.
The guidelines require coverage of contraceptive methods “as prescribed.” This language appears to limit the coverage requirement to contraceptive methods that require a prescription; future guidance may clarify this issue. The guidelines allow plans to encourage lower-cost contraceptives by charging cost-sharing for brand-name contraceptives when a generic is available.
The initial guidance about these requirements allowed a narrowly defined group of religious employers (essentially just churches) to choose not to cover contraceptives and sterilizations as part of preventive care benefits. Many other religious groups, such as religiously affiliated hospitals and universities, will not qualify for this exemption. On February 10, 2012, the administration announced its intention to issue revised regulations. According to a White House Fact Sheet, the revised regulations will:
- Exempt churches, other houses of worship and similar organizations from covering contraception on the basis of their religious objections.
- Establish a one-year transition period for other religiously affiliated organizations while this policy is being implemented.
