Leaving AMA and insurance threat

[gtmoore]

I was told by our risk management department that it is illegal to tell a pt leaving AMA that their insurance will not pay for their hospitalization.

However, I routinely hear RNs telling pts "insurance will not pay" as an incentive for the pt to stay. It works about 50% of the time.

Is this the policy at your hospitals? Does anyone know if there are indeed legal ramifications for telling a pt 'insurance won't pay'?

[feebebe23]

Excellent question as I have always wondered this.....

I have always been told that insurance "might not pay" But I also think that a patients financial arrangement with the hospital and their insurance company is none of the nurses business....

[purple_rose_3]

This is a GREAT question. I'm looking forward to the answer, because I have often wondered this same thing.

[RN4NICU, LPN, LVN]

I agree that it is none of the nurse's business what goes on between the patient, the hospital, and the insurance company. As far as a nurse attempting to coerce a person to stay against his/her will with the threat that insurance won't (or might not) pay, I couldn't say whether or not it is legal, but it does seem unethical.

[TheCommuter, BSN, RN]

I work on an upscale rehab/skilled unit of a LTC, and the cost of staying there is $8,000 per month. Once the patients realize that they might be stuck with a huge bill, they usually opt to stay at the facility. By the way, I would never say or do something to coerce a patient to remain at the facility against their wishes. After all, they have the right to go elsewhere if they feel they're not receiving competent healthcare.

[Tweety, BSN, RN]

It is not true that when a patient leaves AMA the insurance company will refuse to pay, especially if the patient had a covered condition.

It is true that nurses should not be using this as an incentive to make them stay. I'm pretty sure the presumption that it's illegal to say this is not true though. It's wrong, but probably legal.

[dcampbell]

I have left a hospital before AMA (long story) no one threatened me that insurance would not pay, ect. They treated me with dignity and respected my decision. By the way, insurance did pay.

[widi96]

In our ER we are REQUIRED to inform the patient about their insurance (whether it be out of network coverage or AMA). Management also keeps hassling the nurses because it is getting forgotten and they are suppose to chart it.

I don't think that it should be used to coerce the patient, but I would certainly want to know if a decision I was about to make was going to cost me thousands of dollars for a hospital bill. We had one patient that wanted to leave AMA, was told about the insurance possibility, so he called his insurance company (who told them they would still pay) so he left AMA. I think that is the best suggestion. Just inform the patient that some insurance companies won't pay for people leaving ama and that if that is a concern for the patient, they are welcome to call their insurance company before they make their decision - Still leaves the decision completely up to them.

[feebebe23]

I have also heard a "rumer" that if a patient leaves the ER AMA with an IV in that they will try and send the police after them to bring them back to the ER to have the IV removed......just wondering if this had any truth? The legal aspect of this situation would be boggleing....

Also....I can totally see a patient leaving AMA then sueing the hospital for "not telling me that insurance would not pay" .......the whole situation is absurde!!!

[widi96]

Not a rumer about sending the police after patients leaving AMA with a line. We have done it on more than one occassion. Too many IV drug users using the health care system to gain better access for their drugs. Not to mention what a HUGE liability that is for the hospital. As soon as the IV is out, the patient is free to go.

[classicdame, MSN, EdD]

I think any nurse who mentions ANYTHING about finances is asking for trouble. How could you possibly know the contracts of thousands of companies? Best to just try to get to the REAL source, such as why are you wanting to leave? Fear? Try to resolve the issue, not create others.

Janeen

[dcampbell]

Would you REALLY want a patient to stay that did not (for whatever reason) want to stay? I imagine such a patient would be very difficult to take care of. I think if a patient announces their wish to leave AMA, then the nurse/MD should politely explain the health implications of such a decision and honour whatever the patient decides. I am sure that the hospital will quickly be able to fill that bed with someone who is sick and wants to be cared for.