Leaving AMA and insurance threat

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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'?

Specializes in Emergency, Trauma.
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.

If the patient is truly ill, then yes, I would REALLY want the pt to stay. About a month ago, we had a male pt come into the ER by ambulance; EKG showed an obvious acute MI...he didn't believe the doctor or the nurses and left AMA. He should have stayed.

But, many pts who want to leave AMA are not really sick or are fed up with the wait or are just obnoxious...to those I'll give the half-hearted spiel about the risks, and let them go...I'm not going to play the game of convincing them to stay.

About the insurance, I always tell them that its a possibility that the insurance may not pay, and if that is a factor in their decision, they may want to call the ins company before they decide. Depending on the situation, the ins co. may very well pay anyway.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

it's been my experience that if a patient wants to leave ama, they're probably so obnoxious i don't want them to stay. the ones i don't understand are the folks who threaten to leave ama to get what they want. they're npo for the or, and they want a cheeseburger and you won't get it for them so they leave. had a patient leave ama (heart failure patient in his 30s) to go home and harvest his marijuana crop. he was quite upfront with everyone about his reasons for leaving. and we were quite upfront with him that we didn't think he'd tolerate leaving the hospital. he left at 8 pm, went home and harvested his crop, ate a large pepperoni pizza and drank a 12 pack of beer and was back in the er by 6am in pulmonary edema. he went back into the same bed he'd so recently vacated. only now he was sick enough that he was quite pleasant and cooperative!

if someone wants to leave ama and understands the ramifications of that choice, who am i to stop them? it is hard when they clearly don't understand why they should stay and they leave anyway.

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Specializes in OB.
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.

Yes, quite a percentage of the time I would want them to stay. In OB I've seen the result of AMA's fully informed who chose to ignore the facts - ex: a young woman with a completely nonreactive fetal heart rate tracing who opted to refuse an induction and leave AMA because she didn't want her child born on Halloween! Yes, multiple staff members explained and documented the risks. She got her wish - 2 days later she came back in with a fetal demise. Yes, I would have done anything short of coercion to keep her there.

I could care less about the number of beds filled - I just want to see pts. get the best care that can be given.

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Specializes in Rural Health.

We are not allowed to tell patients of the financial risk of leaving AMA. I work in ER. We had a very ugly situation about a year ago involving a patient and staff telling the patient the financial woes of him leaving AMA. It got very nasty and several were place on probation and one was suspended over it because the patient and family made a HUGE deal about it.

We just give them the AMA form, have the doc explain the risks of leaving (if we make it that far) and out the door they go. If they have questions about the $$$ side, we refer them to their own insurance company or hospital billing. I talk no $$$ with people in the ER, it's not my business how they pay.

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Here's the positive side of AMA.

pt out in public and her water broke....someone got exicited and called 911 and they brought her to us.....her hospital was 15 min away from my hospital....

she was ruptured clear fluid, 2cm, not in labor....she wanted to delivery with her doctor at the other hospital...MD can not transfer a ruptured patient d/t EMTALA.....explained her options....stay and deliver with drop in doc or leave AMA and promise to go straight to hospital B....baby was fine....not in labor...signed AMA form and sposue drove her straight to the other hospital.....

no harm no foul......

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It is not legal to make a person stay where he/she does not want to be, either by imprisonment OR by coercion. If a person is not capable of making an informed decision, there are laws and procedures to be followed in keeping them against their will.

I think it would not be unethical OR illegal to advise the patient to contact his/her insurance company about their policy regarding AMA discharges.

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It is not legal to make a person stay where he/she does not want to be, either by imprisonment OR by coercion. If a person is not capable of making an informed decision, there are laws and procedures to be followed in keeping them against their will.

I think it would not be unethical OR illegal to advise the patient to contact his/her insurance company about their policy regarding AMA discharges.

Totally agree. Any adult informing me they are leaving, I quickly explain the risks with another nurse present, ask them to sign the AMA form, and politely wish them good luck. They are adults-life,liberty, etc. (I cannot image working OB, fetal distress AMAs-how does any nurse control themselves when a child could be in danger?-My hat is off to you OBers!)

After reading this thread, I will incorporate mentioning their insurance company, recommending that they call them first. Thanks, good advice.

It might be considered harrassment when you repeatedly request AMA form to be signed, or when a patient is told that their insurance won't pay.

I would never approach a potention AMA without another nurse to witness.

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my insurance policy clearly states that if we leave the hospital AMA that they will not pay. I don't bring up the ins thing to get them to stay, if they don't want to be there and be treated, then what is the point of staying? they are wasting a bed and my time that could be used to care for someone that actually wants it.

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