Case+9+Ethical+Codes+and+Considerations

Ethical Codes and Considerations media type="youtube" key="vFfNxF_Kg8o" width="378" height="283" **Why is Martin concerned that he does not have enough client sessions?" ** It is frustrating to just begin to make progress with one mental health professional, and then have to switch to another professional. The client may feel upset that she has to start over in telling (or summarizing) her story. This has the potential to cause more distress to the client.

Martin should follow through in his fiduciary relationship with his client and his ethical obligations to consider other options for his client’s best interest (Standard A.11.d.). Martin also has an obligation to avoid abandoning clients (Standard A.11.a) and to ensure appropriate termination (Standard A.11.c.) Also, according to Remley & Herlihy (2010), “Because counselors have an ethical obligation to be advocates for their clients ( ACA Code of Ethics, 2005, Standard A.6.a) they must also be skilled at appealing health care companies’ decisions to deny reimbursement when clients need more sessions than their plan allows.” Martin should further review his case notes and consult with other professionals to ascertain if he could convince the health care company further to request exceptions. “It is not the court’s position that a health care provider is not liable if a health plan refuses to provide necessary care, but that the provider does have a responsibility to protest if the recommendation for care is not accepted” Remley & Herlihy (2010). Martin can also “instruct the client regarding the right to appeal a decision that denies additional services [made by the managed health care company]” Remley & Herlihy (2010). It would behoove Martin to establish a good rapport with the case manager of managed care company to help maintain his client’s well-being (as opposed to becoming angry out of sheer frustration).

Martin should assess the client’s situation to see if she is in crisis or an emergency situation. He is ethically obligated to continue treating his client until he can further assist him in some type of financial arrangement for services (or lack thereof, such as pro bono service).

Martin could not institute a sliding fee scale for the client if he has not already been using one, as that could constitute fraud. Therefore, Martin should continue to seek out organizations that will utilize a sliding fee scale. Since Martin is in private practice, he is doing well to assist his client further through pro-bono services. Martin would first have established “clear criteria” describing exactly how certain clients could qualify for the pro-bono service, so as not to appear unfair to his clients who pay full price. This is a great service that is encouraged by the ACA Code of Ethics section A, “Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico).”

Bartering is of course another option that Martin could consider( ACA Code of Ethics section A.10.d.) If for whatever reason bartering, pro bono service, an extension on managed care plan, and a sliding scale fee did not work to continue Martin’s client’s work with him, at least they will both know (hopefully) that they tried as hard as they could in preserving their relationship. If these options did not work, Martin would alas be ethically obligated to refer his client to another professional or organization. Martin would transfer her in accordance with ACA Code of Ethics section A.11.d. (Appropriate transfer of services).

Ideally, Martin would have explained his client’s insurance company’s limitations to her during the onset of the counseling sessions. This way, the client would be informed ahead of time that they may need to explore other options if it appears that she will need more sessions than her plan covers. Hopefully, this would have helped to ease her discomfort if they did need to refer her to another agency that would best fit her financial needs.

**What is the major problem with Martin’s arrangement with Joshua’s parents? ** As for the situation with Martin’s client Joshua, It could appear to an outsider’s perspective that Martin is being incredibly self-serving by utilizing the insurance payment in counseling Joshua’s parents to fulfill his own financial needs. As Remley and Herlihy (2010) state, “We believe that counselors sometimes engage in health care fraud activities because they are motivated to help their clients receive mental health care services that are paid for or reimbursed by health plans. Counselors report inaccurate information to health care plans so that their clients will be able to begin or continue counseling. Unfortunately, counselors also benefit from fraudulent practices, in that health plans pay for their services based on inaccurate information they have provided”.

If the health care company discovers what they are doing, the company could sue Martin and Martin’s clients for fraud, and perhaps collect all of the fees they paid out to them plus other damages. In addition, the company could request that the local prosecutor file criminal fraud charges against all the parties and might also file ethics complaints against Martin with his license boards Remley & Herlihy (2010)

Remley & Herlihy (2010) also state that, “Counselors commit fraud when they report the following to PPO’s or health insurance companies: that the counselor is seeing a client for individual counseling (which is reimbursable) when actually the counselor is providing couples, family, or group counseling (which is not reimbursable)”.

Again Martin has an ethical responsibility to: avoid abandoning his client (Joshua) (ACA Code of Ethics, 2005, Standard A.11.a), to ensure appropriate terminations (Standard A.11.c.), and to help clients find alternative resources for continued treatment (Standard A.11.d.).

Thus, it would be in Martin, Joshua, and Joshua’s parents best interest to seek additional resources that will help with Joshua’s parent’s conflict.

**What is the problem with Martin releasing information about his clients to managed care? ** This could potentially be a client privacy issue. “When clients contract with health care plans, they sign forms that give health care providers permission to provide information regarding their health care to their health care plan administrators. Clients, in the past, believed that they had to agree that service providers could release any information regarding their treatment that the administrator requested. However, the Health Insurance Portability and Accountability Act (HIPAA) has changed that situation significantly. Under HIPAA, insurance companies are limited in the types of information they may request, and they are not allowed to disallow claims if clients refuse to provide them with certain types of information, such as psychotherapy notes. “ Martin is concerned about the fact that HealthCo is inquiring for information such as “the client’s childhood traumas, marital problems, addictions, and other matters”, which appears to be his counseling notes.

<span style="font-family: 'Times New Roman',Times,serif;"> “Many mental health professionals feel uneasy about providing detailed information regarding their clients’ diagnoses and treatment to administrators who usually are not mental health professionals. , information after it is released to the provider. Yet if counselors wish to be providers, they must provide this information. When counselors become providers for PPOs, they should request a copy of the privacy waivers that PPO members routinely sign. If a counselor is ever unsure whether a client wants the counselor to provide information requested from a health care plan administrator, it would be best to ask the client to sign a waiver giving permission for the information to be sent”

<span style="font-family: 'Times New Roman',Times,serif;">Thus, I would suggest for Martin to request a copy of the privacy waiver that his clients sign. In addition, as Remley & Herlihy state, If Martin still feels uncomfortable, he should have a waiver be signed by his client that allows him to release such information. By doing so, Martin will follow the letter of the ACA Code of Ethics 2005 section B.1.b. respect for privacy, section B.1.c. respect for confidentiality, B.2.d., minimal disclosure, and B.3.d. third-party payers. It is important for Martin to realize that privacy is the right of the client, not the counselor.

**<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">How are Martin’s values involved? ** <span style="font-family: 'Times New Roman',Times,serif;">It is important for Martin to realize that he is not having his own needs met through the counseling process. “Knowing your own needs system will help you identify potential areas of vulnerability and sources of therapeutic error. To give some examples, if you have a strong need to nurture others, you may be tempted to encourage client dependency. If you have a strong need to be liked and appreciated, you may avoid confronting your clients. If you have a strong need to feel useful or prove your competence, you may want to rush in and give answers or advice. If you can recognize your potential problem areas, you will be better able to keep the best interests of your clients foremost and less likely to allow your needs to intrude your work with clients” Remley & Herlihy (2010). Thus, Martin will be better able to avoid actions that meet his own personal needs at the expense of his clients Remley & Herlihy (2010). Perhaps Martin has a strong need to be liked and appreciated by others. Perhaps this personal need is inhibiting his obligation to assist a client in achieving autonomy, to assist another client in pursuing marriage counseling separate from him, and perhaps his strong concern about what happens to his clients’ information once released to HealthCo. The ACA Code of Ethics (2005) sectionA.4.b. Personal Values

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