Part 1 Directions Only requires 150 words
Consider the following scenario:
A client comes in to see you for case management services. She has many serious family problems, including
some bouts of depression that seem to be only “situational” based on the current problems she is facing. She
is in need of help, but reports that she cannot afford private counseling. You work for the only mental health
agency in town and the agency charges client fees on a sliding scale. The client is not eligible for Medicaid but
has health insurance through her employer. She cannot afford to pay, even at the bottom of the sliding fee
scale.
After informing her insurance company of her need for services, you find out that the only way they will approve
of services and reimburse your agency is if she has a major mental health diagnosis code from the DSM V
(Diagnostic and Statistical Manual of Mental Disorders) such as “major depression”. Your colleagues tell you
that even though the client does not have a serious enough depression problem to be diagnosed with such a
code, you should diagnose her with one anyway so that her insurance will pay for her services.
What are the legal and ethical implications that exist in this scenario?
If you were the case manager, what would you do in this situation?
Discuss other courses of action, including 3 assessment tools that may exist to help the client receive services
she needs that are both legal and ethical. Explain why you chose each assessment tool and how it might help
this specific client.
state the legal and ethical implications that exist
share what you would do in this situation
discuss other ways the client can be helped
support your ideas with evidence and examples from the text and one additional source
use APA style for all references and in-text citations
Part 2 Direction, Use remaining word count to answer these.
Read the scenario below and respond: asking questions about the information in their post-offer one additional reference that provides support for the material that is addressed by your classmate
references must be cited using APA format
- Danielle Desist
There are many legal and ethical challenges in Case Management. In this scenario, the client’s insurance will not pay for her coverage unless she has been diagnosed with a major mental health diagnosis. She only has situational depression. I would not take the advice of colleagues and falsely diagnose her. This is fraud and it’s illegal. I would look for other alternative methods of getting her help. First I would make an appeal to the insurance for an exception. This involves open dialogue about their rules and the possible granting of an exception. (Woodside & McClam, 2018. ) In the meantime, I would also look into other free resources via online and or support groups. Depression hotlines offer a free and confidential service that is available 24
hours a day. One of the benefits of calling a depression helpline is that everything will remain completely anonymous and private.
2.Brandon Watkins
A lot of challenges are sprung out every day in case management. In this particular scenario, a patient was known to have situational depression. I do not think a false diagnosis would suffice due to it not probably not doing anything. A misdiagnosis describes a situation when your doctor tells you that you have some illness or condition, but it’s incorrect. (Torrey 2020) I would suggest finding treatments that could help lessen the situational depression. I feel it is illegal to diagnose anyone without a seriousness behind it. in this case, it seems as if she needs to be declared diagnosed due to medical bills, which in that case I would give her said diagnoses, however, let her know she is not really. - Elizabeth Mysliwczyk
In this case, I would also try to stick to the ethic and legal route of helping the client. Unfortunately, these types of situations are hard to resolve. What can we as case managers in this scenario do to make healthcare more affordable for individuals without having to rely on insurance restrictions?
not available. Would you consider working for this client for free until you can both work out a plan for the continuation of their care? Or would you decline the client?