Freedom, Flexibility, and Other Twisted Notions about Self-Employment

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Freedom, Flexibility, and Other Twisted Notions about Self-Employment

When I decided for the first time in the 1980s to go into business for myself, my father thought I was crazy. “Why would you want to work 12 hours a day for yourself when you can work 8 hours a day for somebody else?” he asked. “Because they are the 12 hours I choose, Dad!  I might work 12 hours today, but I can work just 4 tomorrow, or even take the day off… my choice! And – I get to do what *I* want to do.” My response was intended to help Dad better understand the flexibility of being self-employed. But he didn’t really get it. Not then anyway. And, it turns out, neither did I. To many people, it seems like the working-person’s nirvana: the notion that when you are self-employed, you work for yourself, call all your own shots, and can be as flexible as you want to be. No boss to lord over you or to require you do things you would rather not do. No having to call in sick if you don’t feel well enough to work. No co-workers who drive you nuts. No having to work with nasty people. No having to justify knocking off early one day, or taking a long weekend – or not even working at all. Freedom… flexibility…. the ultimate way to make a living! But the truth is – that flexibility is often a crock. It’s a figment of the soon-to-be self-employed person’s imagination. Turns out – Dad was at least partially right. Today I’ll share with you some important distinctions that neither of us realized then, but have become so very apparent since. Since that conversation with Dad, I’ve been self employed on and off for about 21 years in service-related businesses (not advocacy, but the basics are the same); long enough to provide you with the real low-down on the flexibility misconceptions of self-employment – with the important addition that I wouldn’t trade it for anything. Let’s begin with that “No boss to require things from you that you don’t want to do”…  In fact,…


 

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Independent Advocacy’s Three-Legged Stool of Success

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Independent Advocacy’s Three-Legged Stool of Success

In response to one of the most frequently asked questions I get as the director of The Alliance of Professional Health Advocates – I might be providing an answer you don’t expect. That’s OK! Because if you don’t expect it, then you may hear it even more clearly than you otherwise would. And that can only be good. I hear the basic questions in a number of formats: Do I need to get a degree or certificate to be a patient advocate?  Followed by, “what degree” or “what courses do I need to take?” Do I need to be certified to be a patient advocate?  or   Do I need a license to be a patient advocate? I already have a degree in ______  (healthcare management, or nursing, or other system-related credentials) – so do I need to study anything else? The answer that may surprise you is this: You aren’t asking the right questions. You don’t NEED any of that. There are no specific degrees or credentials you must have to be a good, effective, independent patient advocate. It’s not about degrees, or certificates, or licenses, or formal education. For today, all you need are these three things: A solid and basic understanding of how the healthcare system really works and the ways to get around it.  NO, not the way it formally educates you that it works. Instead, the follow-the-money nature of the system and everything that entails. A solid and internalized-embrace of independent advocacy ethics. A willingness to learn and execute the business basics of starting, growing, and managing a practice: from legal to insurance to marketing and other aspects, too. Like the three-legged stool, if you are missing any of those supports, you will fall over, and fail. Tough words, but true. And ignored by too many. The problem is this:  so many newbie advocates think that because they have been nurses (or physicians) for decades, they are prepared to be advocates – they are not. Or because they have been managing hospital systems, or physician practice billing departments, they know how to run a billing practice…


 

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Powerful, Useful, and Beneficial — From HBO’s Vice Media: Patient Advocates Can Save Your Money and Your Life

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Powerful, Useful, and Beneficial — From HBO’s Vice Media: Patient Advocates Can Save Your Money and Your Life

In April of this year, patient advocates convened in San Diego for the APHA Summits to mix and mingle, learn, and talk shop… Joining us was the video crew from HBO’s Vice News, led by producer Amanda Pisetzner – a delightful group of young people, with so much talent and enthusiasm, asking great questions… They worked in the background during our networking event, and separately they met with two of our advocates, AnnMarie McIlwain, and Karen Vogel, as they conducted their important work. The crew even met with client-patients who AnnMarie and Karen found were willing to discuss their own situations and results… Bottom line – the most powerful public video we’ve seen, creating a very clear picture of the benefits of independent advocacy and why everyone needs an advocate. We have arrived! (Note: if you attended the San Diego Summits – you might be in the video!) I invite you to watch it – and then I’ll share a few steps you can take, too, not just to help boost your own practice, but perhaps to find yourself the featured advocate in a future media activity. So what do you think? I hope your reaction is WOW!  How can I help?  And how can I get involved in this great promotion of our profession? There are several things you can do: Watch the entire video. Just click on the arrow  above. Give the video a thumbs up. It helps promote both the video and the content. Read the comments.  They will give you a good sense of how someone feels when they first hear about independent advocacy. The people you discuss it with will have similar reactions, and you’ll want to be prepared to answer concerns, or support their positive feelings. Comment yourself.  And – here’s the first step toward helping your own practice – include a link to your own advocacy website! As long as the link is relevant, it’s allowed. Finally – the most frequent question I have received…. how can YOU be included in these great media mentions? AnnMarie and Karen were chosen to…


 

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Help Us Assess the LoveFest!

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Help Us Assess the LoveFest!

Once upon a time, the word “advocate” was contentious: doctors didn’t want us in the room, nurses didn’t want us next to a hospital bed, and health insurers thought we patient advocates were nothing but troublemakers. But in recent years there seems to have been a major shift in attitudes. I’m hoping you can help us assess that. This point came up in several recent conversations with people who have been doing advocacy work for many years; who have been able to observe attitudes for quite awhile, and who tell me they have seen this shift with their own eyes. The shift?  From wary standoffishness – to a lovefest!  As follows: As health and patient advocacy morphed into a full-blown profession (back around 2009-2010) the existing medical system resisted, resisted, resisted. Because of the way the system works (in Canada as well as the US) – with money, not care, at its core — having to deal with an extra person, an advocate who held toes to the fire, meant having to spend additional time, having to provide additional answers, and generally, major annoyance for anyone providing care to patients. Doctors (representing front-line providers), whose time with their patients was becoming more and more limited by outside insurance and practice management forces, were simply frustrated and annoyed. Nurses, especially those who encountered advocates in hospitals sitting by clients’ bedsides, were resistant; they were sure we were there to report them for wrongdoing. Medical billers and health insurers saw every encounter with an advocate as a losing proposition; they knew they were going to “lose” on the amount of money owed once an advocate was finished working with them. But today, many advocates have reported to me that they aren’t experiencing so much resistance anymore.  In fact, they describe a sea change in how they are being recognized and respected by medical providers: Doctors now welcome them into the exam room and patient discussions because they realize that the term “advocate” means the professional is also advocating for them. For doctors, patients, and advocates:  win-win-win. Everyone’s experience improves. Nurses, even those…


 

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Vision, Practice, and Leadership

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Vision, Practice, and Leadership

This post was contributed by Karen Mercereau, RN Patient Advocates A mentor for those who are building an advocacy practice.   Do you have a Vision? Does this Vision underlay the structure of your evolving practice? Are you a Leader in your field? We Advocates who have a vision of what we see as necessary to improve healthcare today, who are inspired to follow that, act upon it and develop that vision into a practice, have a unique opportunity to become Leaders in our fields. Let’s dig a little deeper…. The very fact that you are a patient advocate, no matter what form that practice takes, is proof that you have envisioned a positive change that is possible. Your critical thinking skills and compassion are your guides. Your ever-expanding knowledge base of your field is the working material of your practice. How might you also become a Leader in your field based upon these realizations and skills? How are vision and leadership connected? I. Presentation – how you approach your market – is one key aspect. It is by an understanding of how to present your vision, your idea for change. Oftentimes, people with great ideas are so excited about…


 

 

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Vision, Practice, and Leadership

This post has been shared by the APHA Mentor's Blog. It was written to help you start and grow an advocacy practice.

It is provided so you can find it in a search here at myAPHA.org, but you'll need to link to the original post to read it in its entirety. Find the link to that post at the end of the excerpt.

Link to the original full length post.

 


Vision, Practice, and Leadership

This post was contributed by Karen Mercereau, RN Patient Advocates A mentor for those who are building an advocacy practice.   Do you have a Vision? Does this Vision underlay the structure of your evolving practice? Are you a Leader in your field? We Advocates who have a vision of what we see as necessary to improve healthcare today, who are inspired to follow that, act upon it and develop that vision into a practice, have a unique opportunity to become Leaders in our fields. Let’s dig a little deeper…. The very fact that you are a patient advocate, no matter what form that practice takes, is proof that you have envisioned a positive change that is possible. Your critical thinking skills and compassion are your guides. Your ever-expanding knowledge base of your field is the working material of your practice. How might you also become a Leader in your field based upon these realizations and skills? How are vision and leadership connected? I. Presentation – how you approach your market – is one key aspect. It is by an understanding of how to present your vision, your idea for change. Oftentimes, people with great ideas are so excited about…


 

 

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To Gain a New Client, You’ll Have to Break 2 Bad Habits

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To Gain a New Client, You’ll Have to Break 2 Bad Habits

The phone rings. It’s a new, potential client calling. You answer, “This is Joan Advocate. May I help you?” The client, Juanita, is relieved to hear your friendly voice. She launches into her story about the doctor not listening to her, and that she can’t fill her prescription because it’s too expensive. Then she asks if you can help her. “I’ll do my best!” you reply. Then you begin to address Juanita’s challenges. “Let’ talk about your doctor not listening. Have you tried writing down your questions before you go to your appointment?” No – Juanita has never tried that. “Good idea. I’ll give that a try,” reports Juanita. “But what about my prescription?” “Is it possible there is another drug in the same class? Or even a generic? Sometimes you just need to ask your doctor about those possibilities. He may not realize the one he prescribed is too expensive.” “Thank you so much,” Jaunita answers. “Great idea!” So then, because you know it’s a necessary evil, you ask, “Juanita. You can see I’ve been able to help you. Would you be interested in hiring me to be your advocate?” “What do you charge for your services, Joan?” …. And there we are. The dreaded “how much does it cost?” question. After you tell Juanita what you charge, Juanita thanks you profusely for your help, hangs up the phone, and once again you are frustrated because you weren’t able to convert a call into a paying client. What went wrong? At least two things… Let’s look at these bad habits of yours to figure out how to fix them. Bad Habit #1: Giving Away the Milk We’ve explored this before; the concept of “why buy the cow when you can get the milk for free?“ Look at the conversation above. Juanita posed the problems, and you gave her possible solutions. So why would Juanita want to pay you now that she knows what to do, and can do both of those things herself? She won’t. Not convinced? Then let’s look at it differently. Suppose your hair has become difficult…


 

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Your Pharmacist – Bound and Gagged

This post has been shared by the AdvoConnection Blog. It was written with a patient-client audience in mind, but might be useful to you, too.

It is provided so you can find it in a search here at myAPHA.org, but you'll need to link to the original post to read it in its entirety.

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Your Pharmacist – Bound and Gagged

During the past 10 years or more, the costs of prescription drugs seem to have taken on an enlarging life of their own.  Gone are the days of no co-pay. Today even co-pays seem outrageous, yet pharmaceutical drug companies keep raising their prices and we, the patients, are responsible for their bazillion dollar paychecks, whether or not we can afford the drugs we need. I’ll confess that I have a totally unbalanced sense of awe and loathing for Big Pharma (the moniker given to the whole of large drug companies.)  While on the one hand, I appreciate and applaud the “miracle” drugs some have developed over time, I can’t abide their sales practices, and their pretension that they are trying to help patients. Their goal is only to make money. If they happen to help a patient or two, that’s a pleasant surprise. Sad but true. As a result, when I came upon this article from the AP, I couldn’t wait to share it with you because it can make a true difference for patients, and it gets around their gag rules. Gag Rules? Yes – gag rules.  It turns out, according to the article, that drug benefits companies force pharmacies – all of them from big-box type Walgreens, CVS, Rite-Aid or others… to your small, corner pharmacy – to refrain from telling you ways you can save money when you purchase your prescription drugs. Example:  you need to pick up your prescription for, say, Lipitor. Your co-pay means you’ll pay $50 because it’s a brand name drug.  Your pharmacist is not allowed to tell you, because of the gag rules, that if you purchase it with cash, it will cost you only $25. Now – a bit of a disclaimer – not all pharmacies are beholden to gag rules with all benefits companies (called pharmacy benefits managers).  But don’t worry about that – you don’t need to track them. You can take advantage of this information in one simple way: Always ask your pharmacist how much it would cost you to purchase your prescription with cash.  That doesn’t commit you to paying cash – it’s simply an information-gathering question.  Save even more money by shopping around.  Call several pharmacies to ask them both how much a prescription will cost with your co-pay, and how much it will cost in cash. Then make your choice. (If you have to get…


 

 

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The Sinkhole

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The Sinkhole

Regular readers of this blog know a couple of things about me. For one thing, they know I live in Florida, having moved here from Upstate NY two years ago, no longer willing to freeze my cabungus off during the winter. (Or, as my husband phrases it, “you don’t have to shovel 90 degrees!”) They also know many of my blog posts are metaphorical, based on inspiration I get from my daily life which at times is well, yes, pretty darn metaphorical! And thus we set the stage for today’s post – The Sinkhole. Pure Florida. Pure Metaphor. See what you think. After spending the past several days in Chicago for the APHA Chicago Summits, I returned home late last night to a quiet and peaceful neighborhood, just as it should be. And this morning, all hell broke loose. As I took my little puppy dog for his morning walk, I encountered several neighbors blocking the road to prevent anyone from driving up to, in to, or over a newly formed sinkhole. Sure enough – about 100 yards from my house – a small hole in the road. As I write this post, a few hours hours later, the sinkhole is 10 times that size. It doesn’t appear there is any danger of losing any homes, thank heavens. Looks like we’ll just lose more of the road, curbing and possibly part of the golf course behind it. Sinkholes happen all the time here in Florida. They are not at all unusual. The biggest problem with the early hours of a sinkhole formation is the impossible-to-answer question about how much bigger it will get. What will it eventually swallow? A few years ago, about 100 miles from here, a young man died when a sinkhole swallowed his home – while he was sleeping in it. Could that happen again? And so we will wait and see. Am I nervous? Yeah. A little. As a result, sinkholes as metaphors are on my mind, and the very nature of them has taken on an entirely new thought pattern in my head, as follows….…


 

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B*tching and Moaning – Therapeutic and Educational

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B*tching and Moaning – Therapeutic and Educational

It doesn’t happen often, but when it does, it’s always an eyeopener and usually quite unsettling. When done well, and handled well, it can turn out to be therapeutic, and has the potential for great opportunity. I’m talking about moaning, groaning, complaining and yes – b*tching. Whether it’s a client complaining about an advocate, or the other way around, sometimes it’s fair and understandable, sometimes not. Sometimes it can escalate. Other times it can be diffused. In all cases we can learn from complaints. So let’s take a look. Sometimes Clients Complain about Advocates In the past 10 years, I’ve received a small handful of complaints from clients about advocates they hired, and they are always very disturbing to me. Advocacy is supposed to be about trust and reliance, about smoothing one’s path through the healthcare system. If I see a complaint, I know that hasn’t happened. Last week I heard from a complainer (I’ll call him Tony) who was loaded for bear, but very short on details. He asked how to lodge a formal complaint against one of our AdvoConnection advocates, stating, My family hired a healthcare advocate who is listed as a member of your site and organization. We enlisted in a very intensive program with the advocate; and as things progressed it became clear that she was not only not effective but was actually doing things to damage the healthcare that our family member was receiving. Her performance and her way of working was damaging enough that I am concerned there is risk to other patients that hire her.  Whoa!  That’s quite an accusation!  Then he asked how our “industry” handles complaints. Of course, APHA is not an entire industry, but I sent him a link to our complaint form which explains how we handle this sort of feedback. (You may be interested in our feedback process. It was developed by a task force of advocates a few years ago, with the major goal of making sure any complaints become learning opportunities. It was not set up to punish. It was set up to improve service. It…


 

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The Rest of the Story X 4

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The Rest of the Story X 4

Channeling Paul Harvey today…. (Don’t know who Paul Harvey is?  Maybe you’re too young, or you never spent much time listening to Talk Radio… Paul Harvey was famous for his radio broadcasts called “The Rest of the Story.” His stories always featured a twist or turn, or something unexpected.) Over the past few months, I’ve blogged about points, lessons, or stories, some of which have interesting follow-up or twists to them. So I’ve put them into one post for you – and thus we’re channeling Paul Harvey. What Happened to Sam? In April, I told you about a good friend Sam, who had suffered a heart attack in the ER waiting room. The point to the post was that his neighbor, Tom, drove Sam to the hospital instead of calling 9-1-1, and we were concerned that Sam might not pull through because he didn’t get medical attention quickly enough (knowing that EMTs could have treated him on the way to the hospital, perhaps preventing the heart attack to begin with.) Sam died just a few days after I wrote the post. I cannot tell you how upset we are, not only because we lost our friend Sam, but because we will always wonder if Sam would have survived and recovered if Tom had dialed 9-1-1. It’s hard to lose a friend. It’s even harder to lose someone to poor decision-making. But there is a silver lining to this story. The loss of Sam has raised awareness in our community about calling 9-1-1, when and why it’s prudent, and even which hospital to to go for which kind of medical problem. I hope you can find a good takeaway from the post, too.  Please share it with clients, friends, and family. Be smart about emergencies. Don’t let any of them be Tom OR Sam. Did We Find a Screen? In May I wrote about the absence of logic and what to do instead when I told you the story of arranging for a screen to use at our APHA Summits in Newark.  I explained that I always take a projector with…


 

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Exceeding Expectations

This post has been shared by the APHA Mentor's Blog. It was written to help you start and grow an advocacy practice.

It is provided so you can find it in a search here at myAPHA.org, but you'll need to link to the original post to read it in its entirety. Find the link to that post at the end of the excerpt.

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Exceeding Expectations

This post was contributed by Linda Adler, Pathfinders Medical, a mentor for those who are building an advocacy practice.   I recently spent a weekend visiting my old college campus. I was eager to return to the city I had adored in my youth, the place that had such a deep impact on my adulthood. But I wasn’t sure where to stay, given that the city had grown dramatically, and there were so many unfamiliar options in areas that didn’t even exist in my day. So I went with what I knew, an historic hotel in the heart of the old downtown, close to my first apartment. I made sure to keep my expectations low, given the age of the building, and I figured I’d trade charm and convenience for the newer, more upscale options. Upon arrival, we were surprised to find ourselves in a suite, complete with an enormous, well-appointed living room. A couple of hours later, hungry from the trip, we entered the hotel dining room, and were delighted to see a newly refurbished sitting area and a reworked menu that featured local fish and healthy vegetables: score! Each day thereafter, there was some little detail that delighted…


 

 

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Exceeding Expectations

This post has been shared by the APHA Mentor's Blog. It was written to help you start and grow an advocacy practice.

It is provided so you can find it in a search here at myAPHA.org, but you'll need to link to the original post to read it in its entirety. Find the link to that post at the end of the excerpt.

Link to the original full length post.

 


Exceeding Expectations

This post was contributed by Linda Adler, Pathfinders Medical, a mentor for those who are building an advocacy practice.   I recently spent a weekend visiting my old college campus. I was eager to return to the city I had adored in my youth, the place that had such a deep impact on my adulthood. But I wasn’t sure where to stay, given that the city had grown dramatically, and there were so many unfamiliar options in areas that didn’t even exist in my day. So I went with what I knew, an historic hotel in the heart of the old downtown, close to my first apartment. I made sure to keep my expectations low, given the age of the building, and I figured I’d trade charm and convenience for the newer, more upscale options. Upon arrival, we were surprised to find ourselves in a suite, complete with an enormous, well-appointed living room. A couple of hours later, hungry from the trip, we entered the hotel dining room, and were delighted to see a newly refurbished sitting area and a reworked menu that featured local fish and healthy vegetables: score! Each day thereafter, there was some little detail that delighted…


 

 

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Serving One’s Country as a Healthcare Soldier

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Serving One’s Country as a Healthcare Soldier

Over the holiday weekend – Memorial Day Weekend – I pondered the sacrifices soldiers have made for our country. I expect you did, too. I’m married to a retired soldier. My husband spent 20 years in the US Air Force during the VietNam War era. I’m so very, very proud of him and his service. Patriotic holidays have a special meaning to us because, well, he lived it. (I was not married to him in those years.) We are grateful to, and honor those who served, including those who lost their lives. All this pondering, and the tendency of my mind to wander (!), got me thinking about a different form of service, too. It’s true, that we as advocates and care managers don’t put ourselves in harm’s way.  But I do believe we serve our countries in critical ways. (I say “countries,” referring to both the US and Canada.) We are healthcare soldiers. Now, to be clear. I have no intent to co-opt the spirit of Memorial Day. This is not a suggestion that our service as advocates is the same as the all-in nature of the service of a military soldier. But I do want to share (and ask you to comment on) my thought process about an advocate’s service. We all deserve to be protected from harm, whether it’s political harm or the harm bestowed by a healthcare system that pretends to provide one thing, when too often it falls short, is too expensive, or causes death or debilitation. It requires different kinds of soldiers with different kinds of training to provide that protection. A military soldier helps protect us from harm intended by our political enemies. An advocate or care manager “healthcare soldier” helps to protect us from harm – care or cost – intended or unintended – from the healthcare system. A military soldier learns discipline and ethics in order to defend our country. An advocate soldier learns best practices, standards, and ethics in order to serve patients who must be protected from a greedy healthcare system. A military soldier defends our rights as Americans…


 

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A HUGE Step Forward for Patients: BCPA

This post has been shared by the AdvoConnection Blog. It was written with a patient-client audience in mind, but might be useful to you, too.

It is provided so you can find it in a search here at myAPHA.org, but you'll need to link to the original post to read it in its entirety.

Link to the original full length post.


A HUGE Step Forward for Patients: BCPA

When you run into problems with the legal system, who do you call?  A lawyer, of course. When you run into problems with your taxes, who do you call?  An accountant, of course. If you have trouble with your hair, you call a hairdresser. If the wires or pipes in your house give out, you call a plumber or electrician…. Each of these service careers is represented by skilled professionals who have earned credentials through national certification programs. When you go in search of one of these service professionals, you’ll find most of them have earned a certification* that proves their worthiness to provide services to you – to be paid by you for their expertise. These sorts of certifications are provided by nationally recognized organizations that represent the integrity of the professions, making sure they adhere to specific standards, best practices, and ethics. Independent, professional health and patient advocates have been hanging out their shingles and helping patients for decades. But it has only been within the last few months (early 2018) that these advocates had the opportunity to earn certification to prove their integrity; the skills, abilities, knowledge, and ethics of advocacy. As of this post, 149 advocates have proven their worthiness. They were the first group of advocates who took, and passed, the certification exam. Patient Advocate Certification, using the initials BCPA (Board Certified Patient Advocate) is now a way you can be assured that the advocate you hire has become certified. As time goes on, you’ll want to look for those initials after someone’s name, and for the logo that indicates their achievement.  “Jane Advocate, BCPA” means Jane has proven she has the skills, knowledge, and ethics to help you get the most from, and be treated fairly by, the healthcare system. So, when you run into problems with the healthcare system, who do you call?  A professional patient or health advocate! And if you can find one who is certified, who has earned his or her BCPA, then you’ll have some assurance that he or she knows exactly what’s required to help you, and will do so ethically. To find these advocates, take a look in the AdvoConnection Directory.  *Don’t confuse certification with licensing. Licensing is an activity of a government – “state licensed” or “federally licensed”. Health and patient advocates are not licensed.  Instead they may study, test for, and earn a certification showing…


 

 

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