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.
