On the surface, insurance doesn't always sound like an exciting topic...it conjures up images of salespeople and paperwork and endless phone calls during which actually reaching a human being seems like a holy miracle. But if you're preparing for the LCSW exam or MFT exam, there are concepts related to insurance that can help you PASS the test and prepare yourself for the next step in your career. Let's take a look at a sample test item.
Sample:
A therapist in private practice completes an assessment for a 42 year-old man and gives him a provisional diagnosis of Generalized Anxiety Disorder. The therapist recommends a medication evaluation and weekly therapy and submits the necessary documentation to the insurance company. Two weeks later, the therapist receives notification that the insurance company has determined that weekly therapy is not medically necessary and will not cover this service. What should the therapist do NEXT?
A. Refer the client to an agency that provides low-cost/no-cost services
B. Meet with the client and discuss a private-pay agreement
C. Inform the client of the company's decision and provide the medication evaluation referral
D. Contact the insurance company and advocate for the therapy to be covered
So, while insurance doesn't always seem exciting, it often presents an opportunity for the clinician to do something exciting on behalf of our clients: fight. As social workers, the first ethical standard in our Code is Commitment to Clients. We are bound to promote the wellbeing of our clients, and in some cases, this means going toe-to-toe with an insurance company that is refusing to cover treatment. MFT's have an almost identical ethical standard: to promote the welfare of clients. It has unfortunately become commonplace for insurance companies to reject claims, or to determine that services aren't medically necessary. But if you, the clinician, have completed an assessment and recommended treatment, you've already decided that treatment is medically necessary and it's your job to reiterate this to the insurance company.
Answer:
The best answer to the question above is D: contact the insurance company and advocate for therapy to be covered. A and B might both be good options, but only after you had advocated on your client's behalf. C is not the best answer because the stem tells us that weekly therapy has been recommended as part of the client's treatment; the medication evaluation alone is not enough, and sending the client away with that alone would be irresponsible.
Coming up next week: Privilege
Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you're preparing for a social work exam, check out our Social Work Study Materials. If you're preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.
Looking for more practice questions and some study tips? Check out our new Social Work Exam Study Guide:
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