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.

Being that this is something I deal with in my current scope of work, my first thought to this scenario
was why wasn’t this information documented in the very beginning.

If the counselor would have completed a really good diagnostic assessment and determined that the
client would be going to need more treatment than what their managed care provider will cover, then
they could have made a good referral at the outset. If this would have been completed the first ethical
thing to do would have been to have a conversation with the client informing them that they would
have only a certain amount of sessions left until they stop getting reimbursed, it will give an
opportunity to make a referral at the ending of sessions.

Advocate! Advocate! Advocate! Another way is having the counselors to get back to the insurance
company and advocate to extend coverage when it is needed.

It would be unethical to work outside of your framework when it comes to understanding diagnoses. It
is unethical to make the patients symptoms fit within the context of the diagnosis that is laid out by
the insurance company (Corey et al., 2015). Counselors also should not call the insurance company
listing off the symptoms to a technician and allow the technician to find the diagnosis. Another
unethical procedure would be to just abandon the client. Although you know they may need additional
sessions, you go along with the ending of session before passing on the responsibility. “Abandonment
Prohibited” is the title of section A.11.a of the American Counseling Association (ACA) Code of Ethics,
echoing the NASW and APA codes. The ACA code suggests that “counselors assist in making
appropriate arrangements for the continuation of treatment, when necessary, during interruptions
such as vacations, illness, and following termination.”

Resources

American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.

Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2015). Issues and ethics in the helping professions
(9th ed.). Stamford, CT: Brooks/Cole/Cengage Learning.

https://www.coursehero.com/file/62327624/Topic-7-DQ-2-Ethical-Issues-in-Private-Practice-Community-Counseling-docx/
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