Question about pts leaving AMA...

[NBMom1225]

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:rolleyes:

[BluegrassRN]

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!!!

[wooh, BSN, RN]

At my old job, if there was a problem patient, they'd always get assigned to me, because I was really good at "letting" them leave AMA. "Well I'm sorry sir, but these are the rules, if you're going to be in the hospital, you have to follow the rules."

[belgarion]

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.

i agree. as far as i'm concerned it's don't let the door hit em on the a$$ when they leave.

[JulieCVICURN, BSN, RN]

I know, right? If you don't want us to take care of you, I'm not going to beat myself (and you) up all night trying to force care on you. I don't understand nurses who try to talk the patient out of it. I just lay out the risks and ask them if they'd like a bag for their stuff after the paperwork is signed. I had a woman recently who was very nice, but insisted that she had to leave. She had 90% blockage in 4 vessels in her heart. I told her that she could quite literally drop dead on the ride home, that if a speck of dust fell on her it could kill her. She said she just had to go home and get her carpets cleaned and have a smoke. A week later, she was back on my unit on a ventilator and an IABP. She wasn't complaining then.

[mediatix8]

I don't see why you can't advise them they they might want to contact their insurance company to update them that they are leaving AMA. I think this can be done in a noncoersive way.

[PostOpPrincess, BSN, RN]

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.

when i worked the floor, i saw nurses begging their patients not to leave--as if it was the nurse's responsibility for the patient's well-being at all times.

ladies and gents....i just pull the paper out, tell them, here it is...make sure they truly, truly understand, as well as the family. and get their hospital chariot to take them to their vehicle ( should they have one.)

buh bye....

[jorjaRN]

I can't be 100% sure, because it's been a while since I had one leave AMA, but I think the paperwork we (attempt to) have them sign says something about "the possibility that insurance will not cover the cost of this hospitalization, or subsequent hospitilizations resulting from refusing care" or something like that.

Of course, most of the time they "threaten" to leave, once you set the paper in front of them, they decide the warm bed and free food aren't so bad after all, even if it doesn't come with all you can eat narcs.

[mamamerlee, LPN]

they decide the warm bed and free food aren't so bad after all, even if it doesn't come with all you can eat narcs.

I love that comment!!

I've had people leave because the neighbor will only walk the dog twice a day, not three times.

Or someone they know recently died in the hospital, so that means that THEY are going to die.

Sometimes, you just have to get the papers out, and pack their stuff up.

[wooh, BSN, RN]

I've had people leave because the neighbor will only walk the dog twice a day, not three times.

Well now, there I've got to say, the only reason that wouldn't have me leaving AMA is because my husband would know to leave and walk the dogs that extra time. :)

[Reno1978, BSN, RN]

We had a patient with a history of methamphetamine use present to the ED w/ CP, leave AMA because they wanted to have dinner at Burger King, had a cardiac arrest at BK, and EMS brought them back to the ED. While recovering in the ICU, post-extubation, they wanted to leave AMA again! Some people's children...

[GM2RN]

I don't see why you can't advise them they they might want to contact their insurance company to update them that they are leaving AMA. I think this can be done in a noncoersive way.

You can as long as it's during business hours. This doesn't work for those coming in after 5pm.

[Fribblet]

If I have a patient who wants to leave AMA, I don't argue with them. I plainly tell them their condition may worsen, that they are leaving against medical advice, hand them the form to sign and wave goodbye.

If it's true that insurance won't pay their bill (if they have insurance) then that's their problem to deal with later; it's not mine.

I've got a waiting room full of people who would love to take that bed (some of whom are actually sick), and if someone doesn't want care, then they can do everyone a favor and leave.