Samuel has a private practice and he receives most of his income from clients covered by managed care companies. He is completing the paperwork to get both reimbursement and approval of the number of sessions for two new clients.

Samuel is aware that the diagnosis he gives will affect the responses by the managed care reviewer. The first client, Charlie, has experienced a recent interpersonal loss and has some behaviors that meet the criteria for major depression.

The second client, Amanda, has also experienced a recent interpersonal loss and has some behaviors that meet the criteria for a personality disorder. For Charlie, Samuel knows that if he gives a diagnosis of bereavement he will likely be told that the client does not need treatment and he will not be reimbursed, but if the client has major depressive disorder, then the client may be given six or eight sessions.

Similarly, if Samuel gives Amanda a diagnosis of major depressive disorder, she will likely be approved for several sessions. However, if he assigns a diagnosis of a personality disorder, then she will not be approved for counseling. Samuel truly believes that both individuals could benefit from counseling with him.

Questions

Regarding the case study above, what diagnosis should Samual give Charlie and Amanda? Why?

Do you think it is unethical or illegal for samuel to give Charlie or Amanda one diagnosis or another?

How unethical is it that an insurance company, who has not yet met the client can determine whether they will have services paid for, or how many sessions they can have?