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Mental Health Counselors Discussion

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Ethnic Studies
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Discussion
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Topic 7 DQ2
A managed care clinician completed a utilization review and has just denied authorization for
you to continue treating a client. You believe that the client could benefit from four additional
sessions. At the same time, you understand that the managed care clinician must apply criteria of
medical necessity to justify continued treatment, and you are aware that many of your agency's
clients have problems much more severe than your client's. Make a list of all of the ways that
you could try to ensure that the managed care system does not prevent you from giving your
client the type and duration of treatment services that he or she needs. Categorize each of the
items into two groups reflecting those that would be considered professionally appropriate and
ethical, and those that would be considered to be a violation of professional ethical standards.
According to Knapp & VanderCreek (2008)
Submitting bills to insurance companies requires a formal diagnosis. A particular
insurance policy may award more sessions for certain diagnoses, or not cover some
diagnoses at all (National Conference of State Legislators, 2011). To maximize the
number of sessions a client can receive, and not incidentally increase the number of
sessions that can be billed, an inaccurate or inflated diagnosis is sometimes given
(Danzinger & Welfel, 2001; Kress, Hoffman, & Eriksen, 2010). While this may seem
beneficial in that the client can receive more sessions, it is not appropriate for several
reasons:
1. A diagnosis of severe mental disorder goes on the client's permanent medical records.
That may pose serious problems for clients later and may inaccurately skew future
psychological evaluations or be considered a pre-existing condition by the insurer.
2. Mental Health Counselors and insurance companies need to operate in an environment
of mutual trust. Lying about a diagnosis undermines that trust.
3. Finally, lying about a client, however well intentioned, is unprofessional
and unethical; it violates the principle of veracity or truthfulness and accuracy. (pp 249-
250)
In my opinion, it is not only ethically wrong to improperly diagnose or report anything to an
insurance company in order to get more sessions from an insurance provider, it could have legal
ramifications on the counselor. Although you could make up or worsen a diagnosis, it would be
improper and unethical to do so, even if the outcome could benefit the client. In doing so, it
could cause further damage in the long-term diagnosis and treatment of the client. A false
diagnosis would be in the permanent record of the client. Not only could the counselor lose their
license, it could lead to a criminal record as well. For the false diagnosis to be removed, the
counselor would have to admit to lying to the insurance company as well as putting forth an
unjust diagnosis in a permanent file. It simply doesn’t seem worth the consequences.
Knapp, S., & VandeCreek, L. (2008). The ethics of advertising, billing, and finances in
psychotherapy. Journal of Clinical Psychology, 64(5), 613625. https://doi-
org.lopes.idm.oclc.org/10.1002/jclp.20475

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Topic 7 DQ2 A managed care clinician completed a utilization review and has just denied authorization for you to continue treating a client. You believe that the client could benefit from four additional sessions. At the same time, you understand that the managed care clinician must apply criteria o ...
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