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Will Insurance Deny Payment if You Leave AMA?

Fifty seven percent of all health care providers (and probably just as many patients) believe that if you leave the hospital or the emergency department against medical advice, insurance companies will not pay for the visit. Half of doctors surveyed have told or would tell patients that insurance would not pay the bill if they left AMA.

With 1 in 70 of all discharges in the US being against medical advice, such a policy would have a significant effect on finances for both patients and hospitals (if patients are unable to pay for denied coverage).

Enter a study in last month’s Annals of Emergency Medicine titled “Insurance Companies Refusing Payment for Patients Who Leave the Emergency Department Against Medical Advice is a Myth

Several researchers reviewed 104 AMA discharges in a suburban hospital emergency department and queried 19 insurance companies including HMOs, PPOs, Medicare, Medicaid, and worker’s compensation.

Out of 104 AMA discharges, each and every visit was fully reimbursed by the  insurance companies.

Now that the cat is out of the bag, will insurers change their tunes?

May not be a bad idea to find out what your policy covers before you have to make a decision to leave AMA.

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  1. My understanding is that insurance will refuse to pay for any further care that may be necessary for the condition being treated when a patient leaves AMA, whether the follow-up treatment is as simple as antibiotics or as extensive as an ED visit or readmission to a hospital.

  2. I left an ER AMA one time in college after being told I had to be admitted. I had had a terrible experience at the hospital they wanted to admit me to just a few months before. It was maddening to me, because the condition I had gone to the ER for was fixed, but I had persistent hypoglycemia incidentally while there, and after the 4th amp of d50 I realized they were unlikely to send me home and started getting anxious remembering all of my bad experiences from last admission. So I left AMA. I remember the doctor yelling at me, “You could die!” He wasn’t willing to budge and discharge me at all. The second I got home I realized I had probably just landed myself with a huge bill. I think now, years later, it’s finally safe to say that that bill isn’t coming.

  3. Since Joint Commission wants to make us all personally and professionally responsible for the LWOBS pts (even if they leave ’cause they’re tired of waiting an hour to be seen for sniffles) and chase them out the door and drag them back in…..I’m sure they’ll see this and now make us responsible for mountains of QI and documentation on AMAs. “What did you do to keep the pt from leaving AMA?” “Ya mean other than tell him YOU”RE GONNA DIE?” :P

  4. “Actually, I was going to restrain him, but couldn’t bring myself to drag out your 6 page “Restraint Orders/Flowsheet/q15min documentation of nutritional needs” form.”

  5. Mama On A Budget

    You know, what ever happened to the patient taking responsibility and second opinions. I know most of the time on here we’re talking about drug seekers and ambulance rides for pregnancy tests and advil and mommies bringing Jr. for an ER visit with a temp of 98.9. But sometimes, the patient *actually* does know better and isn’t willing to subject themselves to the “life saving” treatment deemed necessary by one doctor.

    What about all the stories of women in labor who are told they NEED a c-section or they/baby will DIE! Why? Well, it’s 6:00 and mom’s been in labor for 10 hours and, come on now, I know best, sweetie! You can bet I’d be hauling ass out of that hospital AMA as soon as the glimmer of the scalpel shows in the OB’s eyes if everything else is going well (baby’s heart rate is fine, mom’s not running a fever, no signs of infection, etc.). When there are so few insurance companies willing to insure docs who do VBACs, that one surgery would sentence that mom to every other pregnancy ending in major surgery, too.

    No thank you.

    Not that it matters. Hospital lawyers and their judge in the pocket will go chase mom down with a court order – proving once again in this country that a mom has rights over her body if she wants to abort her child, but not if she wants to bring it into the world. Stick me with the bill in that case – just keep your knife off my body.


  6. I tell patients that when I really want them to stay. Kinda like how I say an LP has zero pain when I really am worried about someone.

  7. ERP, that is the most awful comment I have seen here! To blatantly lie to patients because you know better than they? It is hard enough to gain a patient’s trust without having some renegade in our midst who makes a point of lying to patients to get them to consent to a treatment they do not want or feel they need!

    My own approach is to tell the patient that no one has the right to override their choice, especially the insurance company, but that even though as an adult they can make whatever decisions they wish, the one they are making by leaving is not one of their brighter ones (assuming that I believe that, too!). Sometimes there are non-medical factors which override the patient’s need to stay for workup and treatment. Surprise, ERP – even with the white coats, we are no longer dieties!!

  8. Sorry L Sherman, you sometimes have to do what you have to do when you have the patient’s best intersts at heart. If you are really worried about someone and don’t want them to either leave or refuse something, you simply de-emphasize some things and emphasize others.
    I don’t ever truly lie, I just say, “Your insurance company MAY not completely cover this visit if you leave AMA” and “We will do everything we can to minimise your discomfort during the lumbar puncture procedure, we can give you pain medications and sedation if needed”. Versus simply saying nothing of the sort to a patient who I am really not very concerned has a serious problem but medicolegally feel they need to sign out to leave, or saying “A Lumbar Puncture is where I insert a needle in between the bones of your spine to remove some of the fluid in there. Sometimes you may have pain from the injection and sometimes may feel pain going down your leg if the needle is slighly off centre, this is not dangerous but merily uncomfortable” to someone who I really don’t think needs an LP but they keep saying they have “the worst headache of their life” and are repeatedly asking for narcotics.

  9. ERP, your lying to a patient is both illegal and unethical. If I knew who you were I would have your license pulled in a heart beat. But I know that heart beat wouldn’t be yours, because it is evident you don’t have one.

  10. BCBS flat out said in their patient handbook that if you leave AMA, they will not reimburse for the care you’re given. Which means hospital birthers are trapped until discharge :( So, you’d better hope you have a hospital willing to work with you if you have those jerks!

  11. ERP, as a nurse, and as a human being, you disgust me. You don’t care about helping your patient, but about controlling and bullying them. Even to say the insurance company “may” not pay is a lie, because it isn’t true. Insurance companies don’t give a rat’s behind if a patient follows the doctor’s orders. They are not the patient compliance police! Patients have a legal right to refuse medical treatment. Period! If that means they drop dead after they leave the hospital, well, so be it. That is why the patient must sign AMA paperwork – to protect us from liability and take responsibility for their decision. I saw so many instances of patient bullying in the hospital, it would make your head spin! We, as healthcare providers, may know more about medical issues than patients, but it doesn’t give us the right to threaten, lie to, and bully them into doing what we think is best, thereby stripping them of their legal right to refuse! If this is how you treat patients, you have no business being in the healthcare field.

  12. I feel the same way ERP does. Though if you’re getting on my nerves I’ll get you an AMA form in the blink of an eye. Most AMA patients are bothersome and chances are by the time they want to leave, I was ready for them to leave hours before that.

  13. I’ve been in the healthcare field in various levels since 1978, with much of it in EMS. Many “AMA” patients, whether in the field or the ED, are likely making the right decision and saving money, plus exercising that liberty over one’s own body. I’ve heard the Medicare/insurance won’t pay” threat the whole time, even now, by docs, nurses, EMT’s, cops who don’t want someone puking in their squad car, etc. I’ve always thought it was bogus, and it’s reassuring to see that, by and large, it’s true. Having said that, I’ve had more than one “refusal” come back later, only to find a C-4 fracture or ruptured spleen. You pays your money you takes your chances. I WILL choose free will.

  14. Sorry folks, but check your insurance policies closely. Most of the big insurers state in their policies if you leave against medical advice, you MAY be responsible for a portion or all of the hospital bill. The fact that they aren’t enforcing it is reassuring, but doesn’t change the writing of the policy. I would recommend any person check with their insurer before leaving AMA.

  15. so whats the answer? what happens when you leave a hospital without a dicharge?

  16. I would love to find out if my insurance pays if we leave AMA. But, they close in the weekend.
    Our dr. Left for the weekend and did not follow up with us before he left for his mini vacation leaving us to pay and stay in the hospital for 2-21/2 days longer than necessary.
    Of course he will say it was for observatoon etc to cover his butt.

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