Yes – it’s entirely possible you’ve crossed the line and had no idea you did so. In fact, you may be crossing it every day and be totally unaware. Further, except that I’m going to illustrate some line crossing, you might never realize it until you are sued, or arrested, or a client loses out on something important, or you lose your license for crossing the line, regardless of the fact that you had no idea that’s what you were doing.
What line? you might ask…
Actually, there are several – and you may be crossing more than one.
The line crossings I’ll describe here are state or province lines. You may be working, providing options, or discussing life extending or saving tactics that would change from one state or province to another. Thus, if you are providing services based on where you live and work, but you have contracted to work with someone who lives in another state or province, you might be providing guidance that does not apply, or violating contract law, or jeopardizing a license you hold, or otherwise – yes – crossing the line.
Here are a few examples:
Crossing Business Lines
Your Practice Contracts: If you connect with another advocate with complementary skills to further the services your practice can offer to your clients (subcontracting, working with an independent contractor), you’ll need to be sure the contract you offer that advocate adheres to the laws in his or her state. An example: if you have a non-compete clause in your independent contractor contract, and you want to work with a contractor who lives and works in California, then it may not be enforceable, and it may void the entire contract. In many states that do allow non-compete clauses, there is a short time limit (one year) on a non-compete, so if you have a different amount of time baked into your contract, it may make it unenforceable.
This is the specific reason why APHA offers contracts for member use, but we insist that you take them to your own attorney to review.
Your License(s): Many licensed professionals who shift their work to advocacy let those licenses lapse. In that case – no violation.
But if you continue to hold your medical or social work license once you become a patient advocate, and you work with a client who lives in another state or province, you may jeopardize that license if someone reports you for working outside your state lines.
Find out whether you could create a problem for your license by working as an advocate for a client who lives elsewhere, by contacting the licensing board in your state or province.
There are no licenses for patient advocates, so you are not putting an advocacy license at risk by working with a client who resides out of state.
Crossing Client-Related Lines
Advance Directives: Advance directives laws and requirements change from state-to-state and province-to-province. Different ones recognize different directives. For example, in New York, a living will is not recognized as a legal document. The forms with the most differential recognition are POLST and MOLST. It’s imperative you know and recommend the right status for your client, in the state or province where he or she resides.
There is another line that cannot be crossed regarding advance directives. That is: you can (and should!) encourage your clients to develop a healthcare proxy (AKA a durable medical power of attorney – different states use different terms). But you, while contracted as a health or patient advocate, cannot be the designated decision-maker, or the signee, on that document.
The key here is “while contracted.” Read more about handling such a document. Consult the patient’s attorney about whether you can sign such a document if you are living and working in a different state or province from your client. Make sure your signed paperwork reflects the reality of your client relationship.
Health Insurance Rules: The laws and rules under which any insurance company operates vary from state-to-state. In addition, each insurance company that operates in that state may interpret them differently. You may know the rules in the state in which you live and work, but if you contract with a client in another state, you need to be sure that you study the differences in the law from what you are used to.
As most medical billing and claims advocates know, you can ruin a client’s possibilities for negotiation and reduction of bills by making mistakes on the first round of discussions.
Mediator / Mediation: In some states, like California, Florida, and others, the title “Mediator” is a certified and/or licensed activity. Should you offer such services without a license, you are running afoul of the law.
States vary on which mediation services must be licensed, depending on what the venue is (court mediation might be different from family or healthcare mediation). If you find yourself in a role where you are mediating family healthcare decisions (Is it time to move Dad into a nursing home? Do we need to sell his house?), you will want to be sure you check into whether your state requires certification or licensing to conduct such sessions.
These are just a few examples of lines you might be crossing in your advocacy practice. As we continue to strive toward being considered among the most ethical of professions, we need to know exactly where those lines are drawn because crossing them could put our practices or our clients at risk.
Do you know of other lines not listed here that can, but should not, be crossed? Please share them below.
- Health Advocacy Ethics – Conflict of Interest? Or Important Service?
- Can an Advocate Do More Harm Than Good?
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