Insurance/advertisement/fee/referral Flashcards
The patient must have “?” for the therapy to be paid by their insurance. If I made up a diagnosis, it would be -
medical necessity
fraud
If patient’s insurance company denies coverage when a patient does have a medical necessity (diagnose), I have an ethical obligation to -
to advocate on behalf of client.
It is fraud to increase ? of condition to get paid.
severity
It is fraud to bill insurance ? when treating them as a couple.
individually
It is ? wrong to charge higher fee because patient’s insurance pays lower.
legally and ethically wrong
When you are seeing patient under EAP, it is important to discuss limitations such as -
the number of treatment allowed
therapy could be not completely confidential if the focus of therapy is work related.
What needs to be on every single advertisement?
My license number and license designation (LCSW)
When must I discuss fees with patients?
prior to starting a session
When discussing fees with patients, what do I need to include?
methods of payment; frequency of payment; who is responsible for payment (parent/insurance).
When raising session fee, what needs to be given to client?
Ample notice - at lease 3 months. (this must be in IC)
If a client faces hardship (e.g. lost job) and can’t pay full fee, what do I do ethically?
lower fee during hardship
If a client doesn’t pay fee, what am I allowed to do?
send overdue payment to collection agency.
When sending to collection agency, what information can I tell them?
the name of the client
and the amount owed
If client didn’t pay and moved to a different therapist, what am I still obligated to do?
release the record
Bartering for services is only acceptable if-
if it is a common practice among the professionals in that community
AND initiated by client.
It is unethical to allow client to continue therapy when -
cannot pay and have a huge amount of debt.
It is acceptable to terminate client for nonpayment, if -
client is NOT in crisis.
What do I do FIRST if client cannot pay?
discuss payment plan with client
When is it appropriate to refer client out?
1. Client seeks advice outside of-
- outside of scope of practice (medication/psychiatry)
When is it appropriate to refer client out?
2. Terminating client -
- prematurely (e.g. moving/closing practice)
When is it appropriate to refer client out?
3. Client is not making progress even after -
- changing course of treatment and trying everything.
When receiving referral, what am I NOT allowed to do?
giving reward for referral
