Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts: You are on maternity leave, and your supervisor is covering your cases while you are out of the office. The supervisor meets with the client and daughter for the first time today and discusses the client’s progress and her treatment plan goals. The client and her daughter report measurable improvements with symptoms of depression and apathy. During today’s session, the supervisor also learns that you and the daughter went to high school together and share multiple acquaintances. There is no documentation in the client’s chart indicating that the risks and benefits of multiple relationships were reviewed with the client. At the end of the session, the supervisor asks the client for her copay. The daughter and the client state that you have “always just waived the copay,” indicating that the final bill would eventually be “written off by the agency.”  Which of the following statements best reflects the supervisor and counselor’s ethical responsibility for collecting the client’s agreed-upon fees (i\. e

Question: Which of the following statements best reflects the supervisor and counselor’s ethical responsibility for collecting the client’s agreed-upon fees (i.e., copays)?
(A): Collecting copays is not permissible because there was a verbal agreement that the fees would be “written off.”
(B): Waiving copays is permissible only if a predetermined fee-splitting contract exists between the counselor and the supervisor.
(C): Collecting copays through a collection agency is permissible if the client was originally informed of this possibility and previous efforts were made to collect copays.
(D): Waiving copays is permissible when it contributes to the public good (pro bono publico.)

Correct Answer: Collecting copays through a collection agency is permissible if the client was originally informed of this possibility and previous efforts were made to collect copays.
Explanation: In terms of the supervisor’s and counselor’s ethical guidelines for collecting outstanding copays, standard A10d of the ACA Code of Ethics states, “If counselors intend to use collection agencies or take legal measures to collect fees from clients who do not pay for services as agreed upon, they include such information in their informed consent documents and also inform clients in a timely fashion of intended actions and offer clients the opportunity to make payment”Pro bono publicorefers to providing services with little or no financial return. Applying this concept to eliminating a client’s copay after billing insurance is prohibited when billing the Centers for Medicare & Medicaid Services and is ethically risky otherwise. Fee splitting is listed as an unacceptable business practice in sanction A10b of the ACA Code of Ethics. Lastly, verbal agreements about the copays being written off may be a consideration, but this is not the best reflection of the supervisor’s or counselor’s ethical responsibility. Therefore, the correct answer is (C)
Competency: professional practice and ethics