For Premium Members
This is five part series:
This information, and the process for terminating a client, were developed by a team comprised of APHA’s legal advisor, two member advocates who have had client termination experiences, and the site’s administrator.
Scenario: A potential new client has contacted you for help. He briefly describes his situation and then mentions that he used to work with another advocate but needed to make a change, or that he has spoken to other advocates, but they couldn’t help him.
As a business owner, that mention of another advocate should raise a red flag. If he used to work with another advocate, why is he making a change? Or, what did he ask for that the other advocate turned him away?
- Maybe the advocate won’t work with him further because he hasn’t paid her bill.
- Maybe there was a problem in the relationship and the client was no longer comfortable, or didn’t think he was getting what he needed.
- Maybe the advocate went out of business.
- Maybe the potential client lived elsewhere at the time, or the previous advocate did work for a loved one in another state, and he was a long distance liaison.
- The advocate may feel the relationship no longer fosters progress for the patient and recognizes that the patient needs someone with a different skill set.
- Or, as can happen, maybe there was some red flag that popped up and the advocate simply trusted her gut and did not want to work with him.
As you can see, the reasons may be perfectly understandable, or they may spell problems. Regardless, you’ll want to get an answer to that question before you can make a smart decision to move forward with that client.
How do you get the answer? You ask. It’s one of the questions you should ask during your first contact with a potential client, “Have you ever worked with a private professional patient advocate before?” And then, if the answer is yes, “Is there a reason you reached out to me instead of contacting him (her) again?”
The potential client’s answer will help you make a decision as to whether further conversation about a potential engagement is worthwhile.
You may also want to check for reports about the caller in the Red Flag Reports. Advocates who have intentionally terminated their business relationship with a client, or who have been disengaged by the client, or have otherwise trusted evidence that working with that potential client was not in good practice, have provided background information to help other advocates determine whether they want to look further into the possibility of working with that potential client.
How to Terminate an Advocate-Client Relationship
(Note: this information is for permanently terminating an advocate-client relationship. If you hope to work with a client or a client’s caregivers again in the future, this information does not apply and should not be used.)
There may be a number of reasons you no longer want to work with a client. Advocates report clients who don’t pay their bills, a client who refused to adhere to treatment recommendations (but blamed the advocate when his health didn’t improve), abuse from a client, even a client who began stalking his advocate, including contacting a new advocate and claiming the original advocate had not returned his medical records.
There are many good reasons to “divorce” a client, whether or not yours is described above. Only you will know whether terminating the relationship is the right choice for you.
But there are better ways to do it than others, legally and ethically. Simply failing to return phone calls or emails will not accomplish what you hope it will, and could, instead, cause trouble for you down the road.
Here is an approach that has been reviewed and recommended to be sure the process provides you and your client with the information and protection you need:
- Make sure the client knows you are no longer interested in working with him or her, and therefore not to contact you again – or – if the parting is amicable, simply letting the client know you will no longer be available.
- To be to make sure your reputation stays intact. Even if there was a problem with the advocate-client relationship, excusing yourself from the relationship professionally and politely will help prevent damage to your reputation.
To terminate your relationship with a client, follow these steps:
Decide whether you simply want to end the relationship, or whether your client would be better served by referring her to a new advocate.
If you decide to refer the client to a new advocate, and you aren’t sure who might be available in your area, do a search in the AdvoConnection Directory using the client’s zip code, then contact that advocate to see if he/she is interested. Next, follow the steps below as they make sense, being sure to share the information that needs to be shared to help the transition go as smoothly as possible.
If you prefer termination without referral:
- Follow the legal notification steps (see below – these have been developed based on steps doctors and other providers must take).
- Share your information with others if circumstances warrant.
Legal Considerations and Notification of Termination to the Client
Your goal is to be sure there is no question in the mind of your client that your relationship has ended (or will end soon) and that you are not abandoning your client at a vulnerable time. That “vulnerable time” is not easy to define, but these examples may help.
• Example 1: If the client hasn’t paid a bill after a period of time, and termination for non-payment is built into your contract with that client that indicates the work is finished – no abandonment.
• Example 2: if your client has depended on you for transportation to chemotherapy treatments she will continue to get, and you will no longer be providing that transportation, you’ll want to be sure you have made alternative arrangements on her behalf.
The litmus test may be whether or not you have completed your work, and whether or not the client’s improved health status will be dependent on your work with him or her. You will have to decide what the point is.
Be sure to take notes along the way and to keep track of all emails, phone calls or other conversations. The point here is to be able to back up your work and termination outreach. All backup and supporting materials must be in writing in which case phone calls would need to be followed up with something in writing, too.
1. Write a letter and postal mail it to the client, certified mail, signature required. Include in the letter:
- The fact that you are terminating the relationship as of a certain date. There is no requirement to give a reason, although you may include the reason for termination if you want to.
- How any unfinished business will be completed. (For example – if they have not paid your bills, you will file in Small Claims Court on [date].) Be very specific.
- (If applicable) An offer to find a new advocate for your client to work with. (See #3 below.)
- How all records in your possession will be handled: Either those records are included in the same package as the letter – or – they will be provided upon payment in full. They should include:
• A Summary Document that outlines the work you did (your notes), and
• The actual records you hold (suggestion: scan all records that are not digital, then put all records [those that were originally digital, plus those you have scanned] on a CD or DVD that you can deliver to the client.) Be sure to keep these files for your records.
Once the letter/package has been sent, be sure to follow up by completing any offers (or tasks) you have outlined in your letter.
The letter should be sent to the last known postal address of the client. If you have an email address, send it to the email address, too, and copy yourself on the email. Then keep records of these attempts to deliver the information.
2. Notification of Others
There may be other people who should be notified that you have terminated the relationship with your client. If you are listed in your client’s providers’ records, or with the client’s insurance company, you will want to send them certified, signature-required postal mail that asks them to remove you from their records.
You can also be helpful to other advocates by reporting what transpired. AdvoConnection has built a reporting structure that is not publicly or personally identifiable to either the client or the advocate, but can still provide other advocates with a heads-up about problems or non-problems that transpired. In the case mentioned earlier where an advocate was stalked by a client, the new advocate spent hours scrambling to figure out what the real situation was. Knowing some of the client’s history with the original advocate might have saved them all a lot of time and grief.
By filling out the Red Flag Form you will be helping your fellow advocates and possibly yourself, too.
3. Hand Off Your Client to Another Advocate
If your split with your client has been amicable, or does not have negative overtones (maybe you are going out of town, or closing your business), you may want to offer to help your client find a new advocate that can meet his needs. If you do so, be sure to keep notes about the transition, and that you get signatures both for HIPAA purposes, and to show where custody of medical records and your notes lie.