Samuel has a private practice and receives most of his income from clients covered by managed care companies. He is completing the paperwork to get both reimbursement and approval of the number of sessions for two new clients. Samuel is aware that the diagnosis he gives will affect the responses of the managed care reviewer. The first client, Charlie, has experienced a recent interpersonal loss and has some behaviors that meet the criteria for major depression. The second client, Amanda, has also experienced a recent interpersonal loss and has some behaviors that meet the criteria for a personality disorder. For Charlie, Samuel knows that if he gives a diagnosis of bereavement, he will likely be told that the client does not need treatment and he will not be reimbursed, but if the client has Major Depressive Disorder, then the client may be given six or eight sessions. Similarly, if Samuel gives Amanda a diagnosis of Major Depressive Disorder, she will likely be approved for several sessions. However, if he assigns a diagnosis of a personality disorder, then she will not be approved for counseling. Samuel truly believes that both individuals could benefit from counseling with him. Regarding the case study above, what diagnosis should Samuel give Charlie and Amanda? Why? Do you think it is unethical or illegal for Samuel to give Charlie or Amanda one diagnosis or another? Is it unethical that an insurance company, who has not yet met the client, can determine whether they will have services paid for or how many sessions they can have? Why or why not?

Overdiagnosis is an established issue in medicine. According to a journal of the Public Library of Science,

The harms of over-treatment arise from situations where normal life experiences (such as menopause, shyness, grief, etc.) are deemed illnesses, or when diseases are “created” from mild problems and symptoms (such as restless legs syndrome or female sexual dysfunction).

As such, Samuel should be up-to-date on diagnostic techniques and moral practices, which prevent unnecessary harm to a patient (in this case, the potential for denying treatment based on diagnosis).
Samuel’s assigned diagnoses will be part of the person’s medical record and have an effect on how they are perceived; “the stigma associated with being labeled mentally ill, and the considerable costs of testing, treatment, and wasting resources . . . could be better utilized elsewhere.” This is part of managing and affecting a person’s future after treatment. Reviewers for insurance companies, as well as diagnosticians, are required to abide by certain standards of business and practice, which provide lawful and ethical guidelines.
Charlie and Amanda are cases that should be judged individually based on separate circumstances. Charlie exhibits more criteria or symptoms for depression, while Amanda only shows some of the criteria. This does not mean Amanda is less likely to have a disorder. Were they equally comfortable discussing their symptoms with Samuel as a counselor? How did they vary on the severity or extent of each criteria? More information must be used to examine each case. There are a variety of ways to approach this related to different factors of diagnosis for each individual and particular disorder.
Is it ethical for diagnosticians, and by extension insurance companies, to be able to diagnose an individual in a single session? They are required to ask and answer questions that allow for accurate and reliable diagnosis, which are established in mind of the number of sessions that are approved. Sessions generally range from an hour to two hours. Insurance companies must rely on the judgment of the diagnostician. An insurance company, providing a financial role in the counseling process, must rely on the judgment of the diagnostician. This is part of two parties, the insurance company and private practitioner, which work together in order to approve therapy. This is a transfer of knowledge and services provided to the other party with a system of mutual assurance.
A salient feature of these patient and treatment circumstances is the fact that the counsellor receives the majority of his income from clients covered by managed care companies. Though this should not affect his judgment on an ethical level, there is the possibility that he favors diagnosis for patients who are covered by these companies. As such, the counselor should be aware of his own bias, or the potential for bias, on a financial level. If said counselor is motivated exclusively by ethical standards and the wellbeing of his patients, they would not be influenced by their potential income.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665855/