Novice Counselor's blog

Martin was in compliance with the Code of Ethics when he referred a patient suffering from anorexia, a disorder in which he was not trained, to a qualified provider. He was also concerned about a possible breach of confidentiality via HealthCo’s anonymous case managers and its unreliable computer system. He also acted ethically when he refused to abandon a client whose benefits were exhausted. Martin was acting unethically when he used Joshua’s account and diagnoses to bill the treatment of Joshua’s parents (Herlihy & Corey, 2006).

Martin needs to re-evaluate whether he can ethically continue to be a network provider. Should he decide to continue, he needs to carefully review his contract and let all his clients know about the information he will be providing to HealthCo. Martin also needs to reassess whether he is fully qualified to work in an independent private practice as he is rather naïve and uninformed about many issues related to managed care (Herlihy & Corey, 2006). Martin would be well advised to consult with a more experienced colleague about the ins and outs of managed care.

The challenges presented by managed care companies make it more important than ever for counselors to familiarize themselves with the APA Ethics Code and relevant state laws (Acuff, Bennett, et. al., 1999).
The counselor is advised to review all managed care contracts and should be aware of applicable state confidentiality laws (Acuff, Bennett, et. al., 1999).
Counselors should read managed care company contracts carefully to understand any limits on coverage. They should also be aware of the appeal mechanism(s) in the contract and pay attention to any other clauses that could limit patient care (Acuff, Bennett, et. al., 1999).
When patients without financial resources need more treatment and further treatment is denied by the managed care company, counselors should attempt to help them find alternative ways to receive the needed treatment (Acuff, Bennett, et. al., 1999).

To offset the limits imposed by managed care companies, counselors should be involved in advocacy, according to Acuff, Bennett, et. al., (1999).
Active involvement by counselors in the APA, its divisions, and the state psychological associations will further the efforts to offset the limits of the managed care on access to quality health care. Counselors can actively support governmental advocacy efforts to ensure basic patient protections in all managed care policies. This can be done through direct lobbying at the state or national level, and by supporting the state and national political action committees that advocate on behalf of counselors (Acuff, Bennett, et. al., 1999).

Counselors should also develop decision-making processes for ethical problem solving.
According to Acuff, Bennett, et. al., (1999) a decision-making process often includes an examination of the counselor’s personal ethics relative to the issue and an examination of their initial intuitive responses. This should be followed by a series of questions whose answers will permit the rational analysis of relevant ethical issues, the stakeholders, applicable ethical and legal codes, and the generation of possible courses of action.

References:

Herlihy, B., Corey G.; ACA Ethical Standards casebook (6th edition) American Counseling Association, 2006.

Acuff, C.; Bennett, B. E.; Bricklin P. M.; Canter, M. B.; Knapp S. J.; Moldawsky S.; (1999) Considerations for Ethical Practice in Managed Care. Professional Psychology: Research and Practice;Vol. 30, No. 6, 563-575