Does insurance pay for AMA?

  1. I was wondering if anyone knew if, in general (I assume difference insurance companies will have different policies), an insurance company will pay for services if the patient ends up leaving AMA?

    I'm not really concerned about those people who come in and waste my time and resources, then want to leave...I mean, why come in if you don't want to be helped? But what about those well-intentioned people who really did need to be there, the n/v/d who needed the fluids and meds, and then just need to be discharged? They've had meds, labs, xrays/CTs sometimes, ($$$) and have to wait for HOURS for the ER doc to review all the results and discharge them. They feel better and they just want to go home! I really sympathize with those people. I mean, we're all busy and doing the best we can, and the ER docs are swamped, but these people just want to go home. If they leave AMA, because they don't want to wait any longer for discharge (or what if it's an admit and they don't think they need to stay), will their insurance company pay for the services, or will these patients get stuck with a huge bill?

    Just curious.

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    Joined: Sep '05; Posts: 74; Likes: 32


  3. by   cardiacRN2006
    We had a patient once want to leave AMA. We told him that his insurance would not cover the hospital bill if he chose to do so. A little bit later, he rang his call light and handed us the phone-it was his insurance company, telling us they would indeed still pay.
  4. by   GilaRRT
    I know many companies will not pay for AMA situations however. As far as the wait in the ER...long ER wait times are well known in the United States. If you check into an ER, then you should expect a long wait. If you are in fact seriously ill, then you will not be discharged home and should expect a long wait for an admit or transfer. Pretty sad, but that is how it works.
  5. by   BGgirl
    I was under the impression that your insurance company wouldn't pay if you left AMA. This is generally what we tell our pts but their response is usually "I don't have insurance anyways"
  6. by   walk6miles
    We have used that as a "behaviour modification" tool..... I wonder if they pay?

    By the way, we had a Baker Act (72 hours mandated by state of Florida in pschy institution) leave -- she threatened me and called me a fkg cnt... i went to charge and said i couldn't deal with her......
    Chg played "oh, lovey, how can I help you... these mean old nurses.." whereupon the pt pulled her foley out (balloon UP - EEEKKKK) and of course her iv.......then left.... charge called the police and thank god they didn't bring her back to us!!!
  7. by   IngyRN
    I do utilization review at a hospital on the east coast. Insurances still pay the hospital even if pt leaves AMA. The thought is that services were still rendered by the hospital and per contract, regardless of whether the pt chooses to leave AMA, the insurance will pay the hospital. At least this has been my experience.
  8. by   mom2michael
    We used to tell patients their insurance wouldn't pay but we actually have a family file a HUGE complaint against the ER and attempted to find an attorney because we forced a patient to stay against his will and made threats of financial means and gains while he was in the ER. It was a very long drawn out procress and we have sinced changed our AMA procedure.

    We don't discuss payment at all in the ER anymore. If patients want to know if their insurance will pay if they leave AMA - we tell them to contact our billing department during normal hours to contact their insurance directly.
  9. by   loricatus
    I was under the impression until last week that insurance won't pay if a pt left AMA. After being told that most do pay, I realized why----Insurance companies probably think they save money if the patient leaves before the recommended treatment is completed. :smackingf
  10. by   RunnerRN
    When I have a pt who wants to leave AMA, I usually don't say anything about payment. I just tell them the risks of leaving and the benefits to staying, and let them make their own decision. I have on occasion (if it is someone who is AMAing because of the ER being overly swamped, and he/she needs to be seen) that there are some ins companies that won't pay in full if you AMA. I just get so tired of the "Burger King ER"'ll do what I want when I want it how I want it (have it yooooour way, have it your way.....)