Suggestions

Permission for Use

Ethical Allocation of Resources in Provision of Occupational Therapy Services

Conclusion

In attempting to resolve the ethical dilemma Jeanette consulted her Reference Guide to the Occupational Therapy Ethics Standards. Jeanette followed the "Model for Ethical Decision Making" to facilitate resolution [1, p. 135]. Since Jeanette had already determined that she was faced with an ethical conflict and the ethical principles in conflict, she dialogued with her colleagues regarding possible courses of action. She then identified conflicts that arose from each proposed action, which ultimately revealed a possible solution to her dilemma.

After analysis and evaluation of the possible solution, Jeanette met with her manager one-on-one to ensure that she had not overlooked any organizational conflicts and to secure her manager’s support in carrying out her plan.

First Jeanette asked her manager if she could block out an hour in the afternoon, when she did not have any scheduled patients, in order to contact the insurance company about the case. Jeanette’s manager agreed and reminded Jeanette that she should let the family know that she was going to work on securing payment, but in the interim the family should also contact their insurance carrier to appeal the decision. In addition, Jeanette’s manager provided her with the phone number for the clinic’s Patient Assistance Department which helps families set up payment plans and/or secure financial aid.

Next, Jeanette contacted the boy’s mother and informed her of her plan to continue working on insurance coverage. However, she also clarified that there were no guarantees of payment. In dialogue regarding other payment options, the mother agreed to contact the Patient Assistance Department to set up a payment plan as they did not want a delay in therapy while waiting for the insurance company’s final decision. Jeanette also set up a meeting between the mother and her manager to discuss cost. The mother had expressed concern related to service pricing and posed questions as to how the organization decided on fees for service. Because Jeanette did not feel comfortable fielding these questions she deferred the conversation to her manager who had more information regarding billing practices.

After two weeks of ongoing communication with the insurance company, a letter of appeal written by the mother, and a letter of medical necessity written by the referring physician, Jeanette was able to secure payment for occupational therapy services through the boy’s insurance.

In addition, Jeanette went a step further and contacted her state occupational therapy association to communicate her concerns regarding reimbursement. She was told that state-funded supplemental therapy services for children under the age of 5 had been cut in the last two years resulting in limited access to occupational therapy services for this demographic. She was encouraged to write her legislator to advocate for reinstatement of these funds and provide concrete examples as to the negative implication for the cuts.

In addition to the above strategies, Jeanette continues to work with her manager and the clinic’s financial director to implement a system at an organizational level which specifically addresses the needs of this vulnerable patient population.

Jeanette was able to resolve the ethical conflict in the case through a pragmatic approach. While at first Jeanette felt paralyzed to act secondary to the multiple competing principles of beneficence, fidelity and justice, by following a general model for ethical decision making and utilizing professional resources, Jeanette was able to facilitate a good outcome for her patient without violating the profession’s ethics standards.