Who's Gonna Pay If I Leave AMA

So a girl walks into a hospital...

Sounds like the start of a joke, yes?

Let's continue...

So, a girl walks into a hospital 'in labor'. She goes through triage, where they separate her from her birth team for 'a quick few minutes'. The check her cervix, she's 3cm. Her water breaks on the table while they're checking her. An hour later, she's 3cm and her contractions have fizzled. Her birth team still hasn't been reunited with her regardless of  her requests for them.

She notifies her nurse of the fact that she's planning on going home, getting freshened up, meet up with her husband, and they'll probably be back sometime later that evening.

The nurse says they can't leave. She says she's going to leave, even if she has to leave AMA.

The doctor says, that, if she leaves the hospital AMA, her insurance won't pay for her care.

I'm here to tell you that that is a lie.

We have a few possible reasons why they would say this:

  1. they don't know any better and really believe this is true. After all, this has been perpetuated as an urban medical myth for quite some time. 
  2. they know better but use this as a coercive tactic to keep mom at the hospital. 
  3. they know better and have every intention of writing in the file to not bill insurance later so mom is footed with the cost in order to 'pay her back' for not following the doctor's orders. 
The truth of the matter is, I have seen all three as reasons in action. Once, I provided proof that insurance would indeed pay for a clients care even if she left at 24 hours postpartum 'AMA'. He was genuinely surprised and happy!

Many other times, I have seen them back pedal defensively when I bring up the same information with clients who want to leave AMA... getting angrier and more coercive.

And yes, I have actually seen it notated on one nurses file electronically after a mom asked the doctor for the paperwork to leave AMA. The doctor went to the nurse, said something in low tones to her, and left the room. The nurse typed in the notes section, "do not bill insurance as patient is leaving AMA". I called her out on it and the nurse blushed the deepest red. The doctor came back in and blamed it on the nurse, who erased the notes. Later, when mom had birthed and received her bill from the hospital, none of the stay had been sent to her insurance claims department; she called her insurance and confirmed. She called the hospital and they attempted to give her the run around about AMA and insurance declination. She had to have her insurance call the hospital to get it covered.

So, bottom line, yes, insurance will still cover you if you check yourself out AMA. For more information see below:

  • http://www.ncbi.nlm.nih.gov/pubmed/22331399
  • http://thehappyhospitalist.blogspot.com/2011/05/will-my-insurance-pay-if-i-leave.html
  • http://www.amednews.com/article/20120705/business/307059997/8/
  • http://www.epmonthly.com/whitecoat/2010/05/will-insurance-deny-payment-if-you-leave-ama/
  • http://www.uchospitals.edu/news/2012/20120203-billing.html
  • http://patients.about.com/od/atthehospital/fl/Choosing-to-Leave-the-Hospital-Against-Medical-Advice.htm

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