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Client Pre-Authorization Denied For Much Needed Services

Ethics Scenario Archive
1. Approaching Former Adult Client
2. Medical Marijuana
3. Pro Bono Work
4. Supervision Has Multiple Relationships with Family Receiving Services
5. Parent Training Concerns
6. Parents Not Implementing Procedures
7. Soliciting Parent Testimonials
8. Retaliation Towards Mandated Reporting
9. Family Rejecting Safety Measures
10. Parental Collaboration
11. Hostile Work Enviornment
12. Creating Protocol to Prevent and Treat Trauma with Limited Functional Language
13. Parent ABA Practice Questions in OT & Speech
14. Potential Gifts From Clients on Social Media
15. Helping Close Relationships With ABA Tips
16. Parent Utilizing CBD & THC
17. Client Pre-Authorization Denied For Much Needed Services
18. Supervisee Slaps Child in School Setting
19. Changing Direction of Treatment from Previous BCBA
20. BCBA Subpoenaed in Family Court
21. Terminate Services Due To Parent Behavior
22. Parents Offering Token Items During Check Out/Transition
23. Family Doesn’t Want Details Released To Funding Source Without Permission
24. Resources for IRB Approval for Independent Researchers
25. Speech Therapist Refusing To Do PECS
26. BCBA Receives Cease & Desist
27. Unlicensed, Certified BCBA Provide Supervision
28. Rapid Prompting Method (RPM)
29. Parent as Witness to Accident
30. Website Testimonials
31. Student Using Social Media Inappropriately
32. Hiring Behavior Analyst Trainees at a School District
33. College Recommendation Letter for Client
34. Connecting Families That Are Clients
35. Employer Requiring Same Number of ABA Hours for All New Clients from New BCaBA
36. Do we have any ethical guidelines regarding shared work spaces among two companies that provide similar ABA services in a private property?
37. Client Assessment & Discontinuation
38. Caseload Concerns
39. Naptime
40. Systemic Supervision Concern – Clients & RBTs
41. BCBA’s Performing Diagnostics
42. Self-Reporting DUI to BACB
43. Multiple Relationship with RBT
44. Refusal to Provide Documentation
45. Telehealth Supervision

Scenario

You receive an ABA referral from a pediatrician for a 3-year-old client; you call the parent listed and gather insurance details and enough background information to see if the client’s behaviors are within the scope of the practice. The client is severely impacted and engaging in high rates of SIB; your colleague that specializes in SIB has an opening on his caseload. When the team proceeds to obtain prior authorization from the client’s primary insurance, pre-auth is denied as there is no IQ score listed on the developmental pediatrician’s evaluation. Additionally, there is not a standard assessment included on the developmental pediatrician’s evaluation; an additional reason for the denial. The ABA team for the insurance company acknowledges the autism diagnosis on the report but state they cannot process the pre-authorization with the missing components. You explain the situation to the parent; he attempts to schedule another appointment with the pediatrician, but the next available appointment is in 9 weeks. The parent is extremely worried that the child might cause serious self-harm in the interim and is desperate for help. Does our code guide us in how to approach this situation? What are the ethical considerations?

Response

  • 2.01 accepting clients- business decision pro-bono work

 

  • Disseminating information to diagnosing physicians

 

  • Setting up contract to provide consultation in the interim
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