Working with managed care organizations is a reality that
every counselor experiences including the impact
of managed care and its associated challenges from the counselor and client
perspectives.
When clients (or patients) avail themselves of managed care,
they give up the liberty to shop around between doctors, therapist or
counselors and coverage is usually
limited depending on the capacity of the patient to pay. It is distressing that
many stories about Americans not getting the right treatment or at the right
time on their condition because of this. The counselor has the ethical
obligation to do the service to a patient in need even to those who are not
covered by managed care.
The ACA guidelines mandate
that professional counselor will treat clients with respect and dignity,
especially regarding age, color, culture,
disability, ethnic group, gender, race, religion, sexual orientation, marital
status, or socioeconomic status (APA website).
Example of a scenario: A counselor decides to
discontinue services with a client whose managed care organization will not
authorize more sessions.
Find the client alternative
care that will be suitable for the
patient economically or cover the service if the counselor cannot be compensated.
APA continues as advised to all counselee: “Your professional counselor will when necessary, assist in making appropriate
alternative service arrangements. Such arrangements may be necessary following
termination, at follow-up, and for a referral.”
Counselors must also inform clients of all financial arrangements related to
service before entering the counseling
relationship. Clients may request this information in writing.
Second scenario: A
counselor continues providing services to a client without coverage by the
managed care organization.
Pro-bono work has faulty implications for ethics standard of managed care. Everyone’s
goal should be the health of the client and not the takings of health
maintenance organizations (HMOs). Unfortunately,
the current system is convoluted with rules and regulations at the expense of
both the counselor (medical profession) and the counselee or patients.
In the motion picture Sicko (Moore, 2007), the universal
health care plan versus American Health system was investigated and portrayed
the US System or
HMO’s as profit-oriented as most patients
interviewed in the movie were displeased. If this system happens in the middle
of counseling a suicidal or alcoholic on
the brink of death, counselors will be in a dilemma, and the alternatives are few. A counselor who continues providing
services to a client without coverage by the managed care organization may not
only exigent to a counselor but penalized by the managed care system due to
required standard procedures or technical rationality.
To be effective, the
proactive mechanisms and strategies, the techniques must be efficiently implemented as part of the counseling process to
comply with the brief therapy model of a managed care company, while still
complying with the ACA Code of Ethics.
Amidst this seemingly ever-present
source of angst, the counselor professional must remain engaged in advocacy
efforts at the community and professional organization levels to ensure that
the voices of disenfranchised mental health populations are heard, and their needs are addressed. At the same time, counselor
professionals typically also continue to be engaged in devising other
community-based options as stop-gap
measures for consumers in need of mental
health care (Patrick, 2007).
References:
Moore, M (Producer and Director). (2007). Sicko [Motion
picture]. United States: Weinstein Company.
Patrick, P.K.S. (2007). Contemporary
Issues in Counseling. Boston: Allyn & Bacon.
APA Website, 2008, The Layperson's Guide to Counselor
Ethics, Retrieved on November 2, 2008 at: http://www.counseling.org/Files/FD.ashx?guid=606b5973-315c-4118-8b2c-2fbfd8194f82
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