PCN 505 Topic 7 DQ 2
A managed care clinician completed a utilization review and has just denied authorization for you to continue treating a client. You believe that the client could benefit from four additional sessions. At the same time, you understand that the managed care clinician must apply criteria of medical necessity to justify continued treatment, and you are aware that many of your agency's clients have problems much more severe than your client's. Make a list of all of the ways that you could try to ensure that the managed care system does not prevent you from giving your client the type and duration of treatment services that he or she needs. Categorize each of the items into two groups reflecting those that would be considered professionally appropriate and ethical, and those that would be considered to be a violation of professional ethical standards.