Question about pts leaving AMA...

Recently I overheard a fellow RN explain to a pt considering leaving AMA that their insurance company could choose not to pay for the expenses of the current hospital stay if the pt left AMA. I've also heard one of the physicians (who is very full of himself) mention at the nursing station that this was just a myth and that insurance companies do not do this. So, which is it? Does anyone have any experience with this type of situation? It makes sense to me that an insurance company would love to have an excuse to not pay
It's my understanding that the ins. co. can refuse to pay for a return visit if a pt leaves AMA. On a lighter note, A pt left AMA the other day, one of our Nurses, on her way to work, saw him walking down the street. Thinking he was confused & lost she insisted he get into the car & brought him back! Everyone had a good laugh at that one!

When I was doing UR work in psych and individuals wanted to leave AMA during a psych hospitalization, the insurance companies I spoke to urged me to be sure to let the client know that, if they chose to do so, the insurance company would refuse to pay for any of the admission, including the days prior to the AMA discharge, and the individual would be responsible for the entire bill for the entire admission.Many insurance companies take the position that, if an individual doesn't want treatment for something, that's fine with them and they don't need to pay for treatment that clients don't want. (Keep in mind that insurance companies pay quite a lot of people to spend all day every day figuring out how the companies can justify not paying for healthcare for their subscribers ...)

In my education class when I was working ED, they told me you couldn't tell a AMA patient that insurance might not pay the bill. They said it was a form of coercion. Well, maybe so, but doesn't the patient have the right to know that info so he can make an informed choice? I know I'd want to know that if I left AMA.

Fungez I was told the same thing about coercion by a nurse who is also a lawyer. I had never thought about it that way until she explained it to me that way. I now no longer say anything about whether their stay will or will not be covered. The patient does have the right to know but it is not our place to tell them , it is probably in the fine print of their insurance documents.

Through my research I have found that the "insurance won't pay" thing is not true. Obviously, I can't know for certain that it's true for all insurance companies, but the majority will pay for the care you got whether you left AMA or not. Now, they may not pay for a readmission within a certain amount of time if you choose to leave AMA. I don't know about that.

Quote from JulieCVICURNThrough my research I have found that the "insurance won't pay" thing is not true. Obviously, I can't know for certain that it's true for all insurance companies, but the majority will pay for the care you got whether you left AMA or not. Now, they may not pay for a readmission within a certain amount of time if you choose to leave AMA. I don't know about that.

As someone who has worked in health insurance for a very long time, I have never seen this to be true, but it could have been that one insurance company didn't (although they tried every other thing to get out of paying bills, so I don't know why they wouldn't use this!)

Threatening patients that insurance won't pay is an empty threat. The people that are stupid enough to leave AMA aren't going to pay the bill anyway. So if anyone gets "stuck" with the bill, it's everybody else that goes to that hospital and pays inflated prices to cover for those that don't pay.

what i can't understand is why anyone would want to talk a patient out of going ama. usually by the time it gets to that point, they're so obnoxious, belligerent and agitated no one wants to deal with them anyway.

Quote from ruby veewhat i can't understand is why anyone would want to talk a patient out of going ama. usually by the time it gets to that point, they're so obnoxious, belligerent and agitated no one wants to deal with them anyway.

Many hundreds of years ago, when I was just a young nurse, I had a patient who had been stabbed in the chest. He had open heart surgery - the knife just nicked his heart - and had the various and sundry tubes that went along with this. TWO days post-op, he was acting out, and wanting to be discharged.At one point, just after he had eaten his lunch, I walked into his room to find his FOLEY sitting across his lunch tray. He had used the knife on his tray to cut through it. He had already pulled out his art line, as well.He was afraid that the person who had done this deed would come back into the hospital and track him down. The cops were not providing him with any coverage - - remember, this was back in the time of dinosaurs - - and he felt like they would come for him at any time.The docs pulled all his lines and tubes, and let him go.Ya never know. (I can still see that foley sitting on top of the remains of his lunch tray..!)

I would never say this to a patient, because I really don't think it is true.However, I have had a couple of patients ask me if the insurance would pay if they left AMA, and I have always responded that I simply don't know. I don't do the billing, I don't know anything about what is covered and what isn't, and if they are concerned, maybe they need to stay until morning when the doc can discharge them.Once or twice I have had a patient legitimately leave AMA. In that, in their situation, I would have left, too. Some bogus admission by a newbie ED doc who was too scared to send ANYONE home. Most of the time, like Ruby said, there isn't any talk of trying to convince them to stay. I'm helping them pack!!!