Question

Health care insurers often deny insurance reimbursement for certain DSM classifications that are common among clients served by psychologists. Discuss the ethical issues related to upcoding a disorder in order to obtain reimbursement for services.

Answer 1

DSM stands for "Diagnostic and Statistical Manual of mental disorders". It contains various criteria for determining various mental disorders. It contains various descriptive texts. It also guides the doctors for making a communication with their patients.

Up-coding is process of making frauds in medical billing. In this practice the bill prepared remains of more amount than the actual values of service performed. Up-coding is the reality of present time. Many persons take fake bills to make claims of higher amount.

They may also add bills of those tests which were unnecessary in the treatment procedure. Help of some unqualified employees can also be taken to just increase the amount the medical bills. Low quality tests also increase the overall cost.

Sometimes those services are also added which were not required in standard procedure of treatment. These all creates an anarchy for insurance companies. They become forced to avoid full payments due to these reasons. There remains a need of actions from both the sides.

Insurance company must be aware about the whole method of making frauds. Customers should also understand that this act may hamper the financial assistance to those who remains in real need. Companies should also have a human face.

They should also consider the fact that not everyone is a fraud. If a person is genuine and his payment has been deferred then it causes extra burden on patient's family members. It increases their agony by many folds. This condition can be avoided by having an vigilant eye at the starting phase of insurance.

Proper investigation should be made by health officials of insurance company. Customers should also not hide any information. This will ensure a smooth service in the hour of need.