An even more complicated situation arises if and when workers who are paid by third parties such as insurance companies or Medicare must give detailed reports of service to the companies. These reports identify not only the individuals but also the nature of the problem and the course of treatment. In effect, this is a break of confidentiality and a way of influencing the treatment provided. The insurance companies and managed care organizations often may attempt to limit or control the course of treatment. Whom do you really serve – yourself, the insurance company, the client, or all three?