Counseling and Managed Care by Tony Astro

Working with managed care organizations is a reality that every counselor experiences including the impactof 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 usuallylimited 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 mandatethat 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 alternativecare 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 orHMO’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 onthe 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-presentsource 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-gapmeasures 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