respond to two classmates
11111 The therapist was asked to provide HMO with the client’s psychotherapy notes, and these notes are protected by HIPPAA. The clinical records should provide satisfactory rational for medical necessity of treatment. However, the HMO can refuse to extend the clients benefits if the counselor didn’t sufficiently document the client’s medical necessity in the clinical records.
The moral principle of fidelity and standards of B.1.a. and B.1.b. apply to this case study. The moral principle of fidelity applies to the therapist keeping to the promise of his client’s confidentiality and honoring the client’s privacy. In order to maintain the trusted professional relationship and uphold to HIPPAA the therapist can’t turn over the client’s psychotherapy notes. The standard of B.1.a. Multicultural/Diversity Considerationsapplies to the councilor maintaining awareness of his clinical records so that a similar incident does not happen in the future with HMO. Also, the standard needs to be applied to the how the therapist goes about (in a sensitive manner) informing the client of the potential cut in the clients benefits from HMO. In addition, the standard of B.1.b. Respect for Privacy would apply the therapist respect of the all his client’s privacy. In addition, if the therapist asked any questions of the client in order to update the clinical records for medical necessity, the questions he would ask of the client would consist of those needed to further describe the needs of the client for documentation purposes only.
The most relevant information provided in the HIPPA Primer that applies to this case study explains that a covered entity, such as the HMO is not allowed to demand a client’s authorization for their files/ psychotherapy notes in order to receive treatment. Also, the psychotherapy notes may not be requested during an audit of a patient’s records. However, the HMO does have the right to cut funding for a client’s treatment if documentation does not adequately express medical need for treatment.
If I were in this situation I would have appointed a privacy officer. Also, this person would have their Licensed clinical professional counselor (LCPC) and this would be someone I trusted to provide sound advice.
Going forward I would encourage the councilor to have clinical records that sufficiently document the client’s medical necessity for treatment. If this requires hiring a clinical secretary or an intern, then so be it. They should sign the proper non-disclosure paper work and assist the councilor in his private practice record keeping. In the meantime, I would offer the HMO representative the clinical records that provide adequate documentation for medical necessity for treatment. If that was not an option I would look for a way to refer the client to a counselor with a clinic that maybe with the client’s area and provide discounted or free counseling.
2222 The issue here is that the HMO is demanding psychotherapy notes from the clinician, which are usually very private, detailed notes that no one is expected to see but the therapist themselves. In most cases when outside sources ask to see records for specific reasons, the clinician is able to provide the progress notes which are different, less detailed and only necessary information.
I think veracity plays a huge role here because the counselor needs to be truthful to the client from the very beginning about potential breaches to their privacy. This is in addition to fidelity, which definitely holds meaning in the given situation because the clinician needs to maintain the trust within the client-therapist relationship, as it is a huge responsibility. One of the standards that stuck out to me from the ACA Code of Ethics, was B.2.e which mentions that clients need to be informed about the disclosure of their personal information, and that they are involved in the decision making process. Another standard was B.3.d, which states that when it comes to third-party payers, information is only disclosed when clients have authorized it. These are important standards as they may give the clinician initial guidance and proof that they do not have to provide the psychotherapy notes, and to consult the client first to get their opinion and decision in the authorization of it.
The section that I found most relevant in the HIPAA primer was within the section that discussed whether or not insurers could ask for psychotherapy notes, which I believe to be the question at hand in this case. It states that a managed care or health care company cannot actually demand psychotherapy notes from a clinician or that a patient authorizes consent of providing these notes in order to receive eligibility for benefits among other things. These companies can only make this requirement before insurance coverage is agreed upon.
Someone I would immediately consult about this dilemma, before I would even consult with my lawyer or professional colleague, is the patient him or herself. I would discuss this with the patient because as the book says, when it is necessary that confidentiality is broken, it is best to inform the client of the situation, and to invite them to take part in the process. Also assuming that I have had an ongoing dialogue about informed consent and confidentiality with them throughout seeing one another in our sessions, in case this was ever necessary, and so we could continuously collaborate with each other.
My solution for this ethical dilemma is firstly consulting with the client, and secondly meeting with my lawyer and/or another professional in my field, to go through the rules and regulations and make sure I was educated correctly on the subject. I would then try to solve the issue with the insurance company while continuously communicating with the client as well. If the insurance company persists, I would need to take the necessary legal action against them as I am aware of my rights as well as my clients, and that I do not need to give this information to them in order for my client to receive the benefits they
