Changes to F&M counseling services’ payment system undermine confidentiality, detrimental to low income students

By Alison Renna || Contributing Writer

In the last year, F&M has switched from including the cost of health services in tuition to passing the cost onto the student through their private insurance. This is an unprecedented move; no other colleges of our caliber have imposed this burden on their students. Two major problems have arisen as a result of this transition: the accessibility and the confidentiality of counseling services have been reduced. Prior to the transition, F&M included the cost of counseling in tuition costs, so it was automatically made accessible to all students, and automatically included in financial aid. By partnering with Lancaster General Health, F&M has increased the quality of care provided to us, but in doing so has dramatically reduced its accessibility. Through our unique and admirable recruitment strategies, F&M has made a commitment to create conditions of success for its diverse student body. However, the barriers in place of accessing counseling are undermining that. As concerned students, we have found this unacceptable; we love F&M, and we need it to be a place where the resources are provided so that all students can thrive. Anything else is not in our character.

Most of the barriers to access exist in the cost. I’ve outlined the existing health insurance options in more detail below, but our current system can be boiled down to three options: buy a second insurance plan through F&M, use private insurance, or pad your private insurance plan for a $300/semester fee. Many students cannot afford additional insurance, so students are left with the cost of their unique copays and deductibles for each visit. The bill for services typically goes to the primary insured (usually a parent, as we can stay on our parent’s employer’s insurance until we’re 26). If a student needs to access counseling for issues relevant to life at home, sexuality, violent tendencies, or anything else they don’t want their parents to know, they can request confidentiality from their counselor. If the counselor agrees confidentiality is warranted, the college will cover the cost of care so that parents are not notified. However, students feeling less than their best are often not savvy enough to take advantage of this option—instead, they just don’t go.

All the while, the college has used  heavy rhetoric about—and received national attention for—our efforts recruit a diverse student body. This is an incredible initiative, and the praise is deserved. However, F&M is actively disadvantaging many of those those students with this payment structure. Most students simply cannot afford adding a $1800/semester insurance plan, an extra $300/semester fee, or their co-pays and deductibles (which are usually extremely expensive unless you have a really excellent health insurance plan, as few people do) when the payment structure exists outside of financial aid. This marginalizes students from backgrounds that do not value mental health, from difficult economic situations, or who are dealing with issues that must be kept from those at home. This puts some of our most at-risk students in an unnecessarily disadvantaged position.

Right now, there are some resources available for students who cannot afford counseling. There is a fund controlled by the office of the dean of the college which has money for students who cannot access counseling on their own. However, this is a finite fund, and accessing it involves incredible value judgements on the part of the school. The school gets to decide whose financial need is “strong” enough and whose confidentiality is the most important. This leaves us in a sticky situation where only students with good insurance and supportive families can access counseling freely, a small amount of students are able to access aid, and all the students in the middle are ignored. We can do better than this.

None of the arguments we’ve discussed have been enough to persuade the administration to change the system. However, there are more “practical” reasons we need to make a change. As access to counseling continues to diminish, graduation rates are going to drop, the college ranking is going to drop, the school will not be as attractive to talented students, and the value of our degrees will decrease. Faculty have watched for the last year as students fail to complete their classes— overwhelmingly for mental health related reasons. Without providing an environment conducive to student success, F&M will fail to achieve its mission to educate “young people of high promise and diverse backgrounds.”

There has been a small group of students and faculty that has worked with the administration for the last year on shifting the system to eliminate the barriers to access. The administration has argued that because counseling must be paid for through insurance, as we are now part of the Lancaster General Health/Penn Medicine network, there’s no way they can universalize a plan for all students. We have proposed working the cost of insurance into tuition—it wouldn’t cost F&M very much, but it would eliminate confidentiality issues and allow healthcare to be included in financial aid. However, these solutions haven’t been accepted, as they have suggested that insured parents would object to paying a student health fee. The financials surrounding healthcare at F&M are complicated, and the administration has been working hard to navigate the new system and student concerns. However, students are still struggling with the barriers in place, and to my knowledge, there is no immediate plan for making changes to the system. We are excited for LGH and F&M to provide options that can resolve these issues. With faculty and student support, we hope that LGH and F&M will prioritize and expedite a solution.

In a different vein, we would like to question the assumption that counseling must be a part of medical care. There is no reason that basic counseling with a trained professional must exclusively be part of a medical network. We can provide counseling for F&M students without having to deal with with insurance. Most students were provided with basic free counseling in their high schools; it is unthinkable that an institution like F&M, which prides itself so much on student wellness and achievement—as well as tremendous academic rigor—does not provide them.

Throughout this process, the school and Lancaster General have argued that many of the challenges we have outlined are not real barriers, they are merely perceived barriers. However, perceived barriers often function as real barriers, especially in situations as delicate as mental health. There is no reason for the system to only be accessible to students with in-depth knowledge of the inner administrative functionings of F&M. In the situation that they need to access mental health services, fear that their parents will be notified or that they will be unable to afford care is sufficient to keep suffering students from getting help.

Accessible and confidential counseling will be expected by incoming students for the foreseeable future. Because all of our peer institutions provide it, it may become a deciding factor in whether or not students choose to attend F&M, and it has undeniably become a factor in whether students can stay here. We love F&M; there’s way too much that makes this school remarkable to allow its seeming disregard for our mental health to undermine that. But if the administration does not address these issues, the consequences we have described will continue to happen.

Please continue to pressure the F&M administration to reform this system in such a way as to make it accessible and confidential for all students. We all have the same goal: a healthy and successful student body at F&M, and accessible counseling is intrinsic to that vision. If you are concerned about this situation at F&M, please sign our petition. We can let the administration know, quantitatively, how much we care about this. As this article goes to print, the petition has been signed by 667 people. I cannot communicate how overwhelming and humbling it has been to watch the F&M community support one another, voice their concerns, and share their stories.

You seem to understand what the current system does not: we can’t let each other fall through the cracks.

Sign the petition here.

If you’re interested in learning more about the technical details behind the new system, I’ve included a short description of them here. If you’re wondering why you haven’t seen this laid out so clearly before, it’s because the system is remarkably confusing, even in the official literature. The information posted on the F&M website is 19 pages of legalese. I am a licensed insurance professional, and it took me and another agent hours to really figure it out.

Right now, we have three options when accessing counseling. We all start out by paying a $50 student health services fee as part of our tuition, but that does not provide us with any services. On top of that, we must choose one of these three plans:

One: We can use our private insurance. (Usually our through our parent’s employer’s plan, which we can access until we’re 26). This usually involves paying a copay for each visit we access, just like if if you were accessing a doctor anywhere else. However, using private insurance is cumbersome and prohibitive both for financial and confidentiality reasons; copays are simply too expensive for most students to afford for regular counseling through the semester. The visits also show up on the parent’s insurance, and in situations where students don’t want their parents to know that they’re using counseling, this can be enough to keep students from accessing services.

Two: We can buy the insurance plan co-developed by F&M and Lancaster General Health. This is a $1,800/semester plan, and it’s a really awesome insurance package. However, it only applies in network. This means if you live outside of the LGH network—as most F&M students do for half the year—your care will be much more expensive. Essentially, you’ll be paying for two insurance plans—the plan you already have and this one. It’s notable to mention that this is a great plan if you don’t already have insurance and mostly hang around this area of PA.

Three: We can buy the complementary care package ($300/semester), which essentially pads our private insurance with enough counseling and medical services access to make it through a semester. This option makes the most sense for most people, as it’s the cheapest option if you access 7 or 8 counseling sessions a semester, as is the average. The sessions are also confidential. However, an additional $300 simply isn’t affordable for many students. Even for families who can afford it, adding on an extra $300 when one already has insurance makes little sense, and can be especially problematic if the student comes from a background where mental health is not valued.

Junior Alison Renna is a contributing writer. Her email is

This article was written in collaboration with:

Meredith Bashaw, Curt Bentzel, Stephen Cooper, Sean Hyland, Clara Moore, Cecilia Plaza, Bryan Stinch eld, and James Strick.



Photo courtesy of


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