Insider’s Guide: Review of “The Sneaky Way Colleges Try To Sell Students Health Insurance”

This is a review from the article The Sneaky Way Colleges Try To Sell Students Health Insurance
by Ann Brenoff at the Huffington Post from October 10, 2017. Here are the Highlights:

  1. Students must have insurance to be in school. Not only do students need insurance, they need insurance that meets the school’s minimum coverage standards. This standard is different from school to school.
  2. College health plans are often already on the tuition bill. This is a classic aggressive marketing technique of forcing a customer to opt-out rather than opting in. Students must request a waiver if they have insurance that already meets the school’s requirements. A request is just an application, not a guarantee the student will be granted the waiver.
  3. Waiver’s must be requested every year. That’s right folks, not only do you have to opt-out from insurance, you have to opt-out each year.
  4. Premiums vary from campus to campus and can inflate the cost of going to college significantly. There is no standard for premiums. The average cost is $1,500 and $2,500 per year.
  5. There is often little choice. Schools often have one or very few health plans and often have health centers who do not accept anything other than the insurance they sell.
  6. Rules for waivers vary. Some schools want to see low in-network deductibles while others want to ensure there are adequate in-network providers in the school’s area.
  7. Students can take out loans (or use scholarship money) for insurance. Since insurance is a line item right next to tuition, loans and scholarships are fair game for paying for insurance.
  8. Big impact on students if the Affordable Healthcare Act changes. If the employer mandate or the coverage for kids 26 and younger is removed, the burden of insurance will pass from the large employers to the students and their families.

My opinion of the article and it’s focus is that students should definitely be mandated to have insurance while at school but there should be government oversight for what insurance is offered, how it’s disclosed to students and what provider options exist in the school’s area. Right now college insurance seems like the unregulated wild west and most families don’t even realize it. When we pay for something, we should have a right to know what we’re paying for and not be forced to opt-out. Often, this insurance payment is in addition to a ‘Health Fee’ which covers minor health and wellness interventions. For example, here at Indiana University’s counseling center (CAPS), there is a $30 fee for each session during each semester after the first two ‘free’ sessions. IU does not accept insurance and offers to provide an itemized invoice that can be sent to a student’s insurance company so the family can be reimbursed.

I recommend that if you have a kid that’s heading off to college next Fall and will likely need healthcare support for medical or mental health, do your homework to find out whether their health centers accept your insurance. Research how to complete the waiver and make sure you know how much out of pocket healthcare expenses could be.

Anxiety and 7 Ways to Help Your Struggling College Kid

As excited freshman or experienced sophomores, juniors and seniors settle in for another Fall semester around the country, I wanted to put together a quick list of 7 things parents can do to hep their college kid suffering from anxiety. It’s scary to put so much freedom and responsibility into the hands of your son or daughter when you know worry and fear is always lurking around social, academic or career decisions. Before I discuss what to do about anxiety, I think it’s important to review some details about anxiety.

Everyone feels uneasy or anxious occasionally like when we are running late for a meeting or got caught doing something we’re not supposed to. It’s a normal.

Anxiety disorders are different than regular, situational anxiousness. They are a group of mental illnesses that are characterized by intensity, duration, origin and how they impact life domains like work/school, relationships, and health.

For people who have an anxiety disorder, worry and fear are constant and overwhelming, and can be disabling. With the correct treatment, most can overcome the anxiety disorder and lead a fulfilling life.

Types of Disorders

Anxiety disorder is a broad category that includes:

  • Panic Disorder. Feeling overwhelming sense of terror or dread that seemingly strikes randomly. During a panic attack, the person may sweat, have chest pain, and feel unusually strong or irregular heartbeats. Sometimes they may feel like they’re choking or having a heart attack.
  • Social Anxiety Disorder. Also known as Social Phobia, this is when someone feels overwhelming worry or judgement while in social situations. They may obsess over others judgment or being embarrassed or ridiculed.
  • Specific Phobias. This is when someone has a very specific fear of something such as spiders, heights or flying. The fear goes beyond what’s appropriate based on actual risk and may cause them to avoid regular situations.
  • Generalized Anxiety Disorder. This is what I see most when working with college students. They describe having excessive, unrealistic worry and tension with little or no reason.

Risks

Early signs of anxiety are super subtle and include distractability, avoidance and sleeplessness. Students with anxiety disorders often report to me that semesters generally start fine but as papers, tests and social pressures mount, their anxiety builds to the point where they start consider drastic changes like dropping out of school. Untreated anxiety can lead to depression, severe drug use and in some instance, suicide. Anxiety and depression seem to be best friends, often presenting together in college students I’ve worked with. 

What to Do

Though anxiety disorders can make someone feel hopeless, there are very effective treatments and interventions we can implement to get their life back on track. Here are the 7 I think are most important for parents to be aware of if they need help with their college kid.

1. Counseling

Right out of the gate, the first thing parents should do is link their child with a) campus health services (often called Counseling and Psychological Services or CAPS) and b) a therapist or counseling like me specializing in college student anxiety in the community close to campus. Ideally, find a therapist/counselor that uses Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT). Waiting until the first big meltdown could be too late. Loads of freshman fail to share their struggles with their parents until Thanksgiving and Christmas which, by then, is too late in their minds and they end up not returning for their Spring semester. Invest the time on the front end.

2. Scheduling

Anxiety is fed by fear. Fear is often the by-product of lack of predictability about social events, academic outcomes, and career failures. One solution is increasing predictability. I accomplish this with students by teaching them to download the semester schedule onto their phone calendars before the semester starts. Next, after they’ve received their syllabi, I coach them to put in every single date for every single assignment/test possible. This also includes social events and any non-academic stuff they know about. This may sound like it could be overwhelming, but I’d rather have them feel a bit overwhelmed when looking at the calendars rather than anxious about remember when that next big thing is due.

3. Resources

Not the most used suggestion but one we have to put here – make sure your son or daughter has a list or access to resources that can help them reduce stressors or mitigate things when they’re already starting to spiral down. These resources could include the academic supports found at nearly every university or within the community. Universities have a vested interest in making sure your son or daughter doesn’t bail at semester’s end. Another form of ‘resource’ is the on-call list. Create a formal or informal list of people they can call/text when they are starting to feel overwhelmed. I am on-call for all of my clients and often receive texts from students the night before big tests asking for help in quiet their brains down. I call them or text back strategies and remind them to call if they want to talk through things in more detail. Just knowing there is a safety net and team of support can have a dramatic reduction effect on anxiety.

4. Medication

I am super conservative with medication use and recommendations for students I work with at Indiana University. But, with that said, we also recognize that some folks simply need a bit more support than what counseling and academic support can provide alone. If your college does not have a psychiatrist on staff, we highly recommend finding one in the local community. We rarely encourage use of primary care physicians or nurse practitioners for medication management since they are not specifically trained to diagnose and medically treat those suffering from anxiety. You also want your college kid to work with someone who genuinely understands the risk of some medications that have the potential for addiction. Good kids get hooked on meds the same as bad kids. It’s also important to avoid illegal or non-prescribed drugs (like the roommate’s Xanax).

5. Meditation

I recommend to nearly every client to start participating in weekly yoga, meditation or mindfullness classes. This is an evidence-based approach with only positive side-effects. Plus, every college offers these in their wellness programs for free so encourage your kid to take advantage and put it into the calendar. Meditation, counseling and medication are an incredibly complimentary approach to combating anxiety.

6. Sleep

Not easy when kids have more freedom than ever away from home but we nonetheless push parents to encourage sleep. Not binge sleeping but a healthy 8 hours per night. The ideal for anxiety reduction is a steady sleep pattern so that bedtime and wake time are pretty standard every day. Staying up late on Thursday, Friday and Saturday, sleeping in till 1:00pm and then dragging out of bed Monday morning for an 8:50am class is terrible for anxiety.  Sleep meds only make things worse and really should only be taken with the psychiatrists oversight.

7. Exercise

Encourage your kid to sign up for the intramural leagues, especially for sports where there is little standing around time. Distraction and flow experience are essential in helping him or her focus on non-academic activities. It’s also a great way for them to be social without needing a drink in their hand.

Ok folks. Hope this helps you figure out the best way to help that college kid who may be struggling as you’re getting through the fear of letting go. It’s an exciting time and, with the right strategies in the beginning, can be the start to a fantastic semester.

Mental Health Support on College Campuses: What Parents Need to Know

Most larger universities like Indiana University (close to where my office is located) have health programs called CAPS which stands for Counseling and Psychological Service. They are often staffed with licensed therapists/counselors and psychiatrists with a range of experience and expertise. Their primary goal is to act as a stabilizing resource for most mental/behavioral health or substance use issues. Many university CAPS typically offer individual, group and couples counseling along with occassional free workshops. Here’s the list from IU CAPS on what they typical help with:

  • Academic Concerns
  • Relationship Concerns
  • Stress Management
  • Power and Privilege
  • Time Management Help
  • Sleeping Issues
  • Adjusting to College Life
  • Anxiety
  • Depression
  • Substance Use
  • Body Image, Eating, and Exercise Concerns
  • Sexual Assault or Abuse

They have the same confidentiality requirements as counselors like me off campus but are limited in many ways. CAPS limits the number of unpaid sessions (IU CAPS allows for two) and mandates that a student must be working with one of their counselors if they want to meet with a psychiatrist for medication management/evaluation. Here’s a breakdown of IU CAPS fees:

COUNSELING  With IU Health Fee  W/O IU Health Fee
First two sessions (per semester) No charge $55 per session
Additional full sessions $30 per session $55 per session
Additional half sessions $20 per half session $35 per half session
Additional group counseling $15 per 60 min. session

$17 per 90 min. session

$29 per 60 min. session

$35 per 90 min. session

PSYCHIATRY
First visit $55 $105
Follow-up visit $30 per visit $55 per visit

IU CAPS does not accept insurance but does provide a super detailed invoice to be submitted to a student’s insurance company for reimbursement.
Over the last few years, I’ve noticed many CAPS programs around the country have had a huge increase in demand for their services while also having budget cuts or mediocre increases that leave them without the full team of professionals they need for each semester. At IU CAPS, every one counselor is responsible for 2,110 students (yikes!). This is not a new problem at IU and not isolated to IU.

So what can a parent or student do? If CAPS doesn’t seem like a good option, look for a therapist/counselor convenient to campus who specializes in college students. Therapists should be flexible to accommodate busy course loads and social events. In my practice, I have extended evening and weekend hours since many students a slammed with class 9-4pm most days. It’s also important that the therapist be willing to talk with parents and provide updates and suggestions. Parents can sometimes feel like their kids are a million miles away. A good therapist can often act as a bridge and lower the anxiety associated with having kids at school.

Finally, talk with CAPS (or encourage your son or daughter to) the first week of school. It’s easier to cancel an appointment than to stand in line after all the students are back on campus. The intake process should be thorough and your kid shoul feel like the therapist/counselor will really understand their issues and help.

Don’t Think Pain Meds and Heroin is Really a Big Deal? Check Out What the Surgeon General Just Did…

Surgeon General Writes to Every Doctor in U.S. About Opioid Epidemic

Opioid abuse is not like other problems. With very little use, pain meds and heroin can quickly become an addiction. This addiction has unusual drug dealers. Some are intentional (Big Pharma like Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis) that exploit our pain and desperation. Other’s are likely well-meaning like primary care doctors most of whom are manipulated by the pharmaceutical companies to write prescriptions.

If you or a loved one is prescribed pain meds, take this seriously. Use as little as possible and work closely with your doctor. If you can’t stop, get help immediately. The longer someone abuses opioids, the harder it is to get back on track.

5 Signs of Suicide Risk in College Students

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

There is nothing more exciting than dropping of your college freshman in late August as the cool nights of Autumn return. But not all students carry with them the same energy and positive outlook for the Fall. Some are carrying some heavy baggage from High School or even younger while others don’t start to develop any major issues until they first get to college (and their first taste of freedom from parents). What parents don’t know is that you likely know your college friends (or at least a side of them) better than their own parents do, and you may be able to tell that something is wrong way before anyone else. This quick list is as much for parents as it is for you students out there. 

The following signs might indicate a student is considering suicide:

  1. A good student who’s behavior suddenly changes – they start ignoring assignments and missing classes which are likely signs of depression or drug and alcohol abuse, which can affect their health and happiness and put them at risk of suicide. And yes, good students and good kids use drugs. Seriously. 
  2. Anyone who doesn’t have friends or who suddenly rejects their friends may be at risk. A friend who suddenly rejects you, claiming, “You just don’t get it,” may be having emotional problems.
  3. College students may be physically or emotionally abused by a member of their family or their girlfriend or boyfriend – or suffering from abuse that occurred long ago but triggered by the new college environment. Abusive relationships can make a college student feel like crap about themselves. Signs that a person may be in an abusive relationship include unexplained bruises or other injuries that he or she refuses to discuss. 
  4. This is a common one – Significant changes in a someone’s weight, eating or sleeping patterns, and/or social interaction style may indicate that something is wrong. Eating disorders are super common at college. Lot’s of perceived competition, anxiety and stress that translates into really unhealthy views of one’s self. 
  5. Coming Out? College students may suffer from depression or have thoughts of suicide if they have a difficult time adjusting to their sexual orientation or gender identity. Gay, lesbian, bisexual, and transgendered students have higher suicide attempt rates than their heterosexual peers.

We understand regret and their could certainly be a real consequence of getting help for someone who seems to be really hurting. They might get pissed at you for not minding your own business. But think of it this way – is the regret of possibly losing a friend better or worse than the potential of knowing you could have saved your friend’s life but did nothing? Tough choice but that’s part of the burden of mental illness. 

7 Personal Finance Tips for College Kids

Yup - More advice for college kids.

Yup – More advice for college kids.

Chapel Hill is once again overrun with the bustle of students back at UNC. Restaurants are packed and campus is vibrating with the nervous excitement that envelopes our small town each Fall. Unfortunately, not all students are prepared to take-on the privilege and responsibility of freedom only a college student can experience.  Here are 7 Personal Finance Tips we have used with other kids and their parents. 

1. Finish Your Education

The only thing more expensive than a life without a college degree is a life with a partial degree and student loans. If your college student is struggling at State Univ with a bazillion other kids, take the next semester break to meet with a career counselor or clinical education consultant to discuss what about Big U. is not working for your kid. Don’t dump another penny into education until it’s towards the most effective environment for their learning. 

2. Set a Budget
Sit down with the parents, figure out what they are willing to provide either monthly, semester or for the whole year. This is your ‘income’ essentially. Next, calculate all your Essentials or Needs (beer is not a need). Things like printer cartridges, meal plan or food money, gas money if your off campus, text books. Next, figure out your Wants (this IS beer money). Add your Needs and Wants – this is your estimate in expenses. Break it down per week since doing it by months does not fit well with semester length. If you have $100 per week for your entire budget and your parents do a great job of ignoring request for additional injections of cash, you will quickly learn how to use a budget. We encourage parents to not put a lump sum in an account everything month – it’s way too tempting to blow through that in a week. Instead, put it in weekly based on the budget you all came up with. Any adjustments should be made during semester breaks in person. 

3. Invest (… a little)
What you’re lacking in capital (ie. $$$) you can make up for in time. With very little money put aside either each month or year, you’ll be able to take advantage of compound interest – the most magical of money making secrets. Here’s an example:
Let’s say you took $1,000 invested it August 2014 in a mutual fund with an interest rate of 5% per year as you were heading of to NYU for Fall classes. Each subsequent year, you put in only $250. After you graduate you get a job – not your dream job, but something that covers your bills with a little extra. You continue to put in $250 per year and do this for another 6 years. The total amount you invested was $1000 + ($250 x 9 years) =  $3250. But the cray thing is, your money has been quietly making little money babies in your mutual fund and the total value is actually $4,930.59. Nice. That’s $1700 in income you made without lifting a finger. What another magic trick? Put no more money in EVER and when you are 59 years old, that same $3250 will be worth $24,023.96. Play around with this calculator to see more about what money does over time. 

4. Learn Finance Basics
This is a great time to learn the basics about taxes, expenses, budgets and cost of living. Waiting until you’re 29 years old, married with a child on the way is the wrong time to start learning. Take advantage of any finance classes available at your school. Ask to help your parents during March and April while they prepare for taxes. The absolute most hardcore way to learn personal finance from my perspective is to start a business. This pushes you to understand basics of cashflow, expenses, revenue vs profits, taxes, selling, marketing and negotiating – all skills totally transferable to most other life domains. 

5. Lock Up Your Money
If you are a student and have money of your own either from a job or money from parents – consider putting it aside till you graduate. How do you figure out what to put aside? This is where our fancy-schmancy budget comes in. Figure out your reasonable realistic expenses for a semester X 8 semesters = Four years of college expenses. Life below your means (ie. income) and invest in yourself through education, relationships and experiences. Ignore all the crap other students stuff their dorms and apartments with and focus on yourself, getting the most out of your four years with low responsibility and high freedom. 

6. Get a Credit Card
The old school wisdom was to never get a credit card. Ideally, that sounds great – pay for everything with cash. Reality is credit (FICA credit score, that is) matters and credit cards are a great way to start building a great score. We recommend getting a credit card with a ceiling or spending limit that gets paid off each month. If the credit card is only used for school purchases like books, computer stuff, etc. it makes tracking the expenses for deductions and tax purposes way easier. It also helps provided easy tracking for expenses as relating to your new budget. Finally, it allows parents to easily review and pay the card balance while also getting card points if parents are in fact covering the bill. How to find one that fits? Try out Nerdwallet for some reviews on cards that seem well suited for the responsible college student. 

7. Work (…a little)
If you are privileged enough to not have to work while you’re in school, it’s not a bad idea to pick up a small part time job (or start a side business – ideas include laundry pickup, tutoring, making t-shirts). This will help build your resume and put some money in your savings account you’ll be able to tap when you graduate. If you’re taken out student loans, you’ll have to start repaying them within a few months of graduating so having a bit of a cushion in the bank will help lower your anxiety if finding a job or getting into grad school is tricker than planned. 

Ok, hope this helps get you all excited and prepared for the Fall semester. Contact us if you have specific questions about personal finance or career counseling for your college kid.