Last month, the California law and ethics practice question tested your knowledge on HIPAA. This month, we are continuing with this theme and exploring insurance more generally. It’s possible, though highly unlikely, that you have avoided working with insurance thus far. Regardless, the BBS expects you to be familiar with the issues that arise when working with insurance. You can definitely expect to be tested on the subject. And while this blog cannot address every insurance-related issue, it will provide you an opportunity to test your knowledge on a key issue for the topic.
How might the subject be tested on your California law and ethics exam?
You could be tested on:
- Managing client information.
- Legal and ethical issues regarding insurance billing.
- Audit requirements.
- Advocating for coverage.
Let’s test your knowledge of this subject and see how you do!
A therapist working in private practice accepts clients through insurance. The therapist has been working with a client who has a diagnosis of obsessive compulsive disorder. The insurance company approved weekly sessions for one year, but the therapist believes the severity of symptoms requires additional sessions. What ethical responsibility does the therapist have in this case?
A. Encourage the client to advocate for additional sessions with insurance company.
B. Submit a request to insurance company describing severity of symptoms and justification for additional sessions.
C. Develop a treatment plan in accordance with the number of sessions approved through insurance company.
D. Offer client additional weekly sessions and encourage them to pay out-of-pocket rather than utilize insurance.
(scroll down for answer and rationale)
The correct answer is B.
Answer A may be tempting, but it is incorrect. It’s possible that a client will need to interact with their insurance company and advocate for themselves at times. However, it would not be appropriate in this situation. The client lacks the training and skill set needed to advocate for additional sessions as effectively as the therapist.
Similarly, answer C might be tempting. However, the question stem clearly indicates the therapist believes additional sessions are required. The starting point would be to receive the level of care that matches the client’s needs.
Answer D is incorrect because the client is receiving services through their insurance and it would not be in their best interest to reject insurance outright.
The best answer available is B. The therapist should advocate for their client to receive the level of care indicated. In this case, additional weekly sessions are necessary to properly address the severity of symptoms. The therapist could more effectively advocate for the client by explaining the medical necessity for additional weekly sessions. Generally, insurance companies require the presence of medical necessity before reimbursing for services.
How did you do on this question? Does the correct answer and rationale align with your understanding of working with insurance, or did you learn something new? If you have any additional questions, you are welcome to check in with a TDC coach. Our coaches are here to answer your questions and provide support and guidance as you prepare to PASS your California law and ethics exam with confidence!
If you aren’t already signed up for one of our excellent exam preparation programs, check out our social work and MFT customer testimonials and sign up today! Our structured, straightforward approach will provide you with exactly what you need to successfully answer questions like these and many more-correctly and with confidence.
I was able to choose the correct answer because I work with billing medical insurance as well as therapy with the clients in the state of Michigan we are driven by insurances and most times if you had no authorization your client could not get the mental heath services needed, Its called Community Mental Health ,