Do patients pay when they leave against medical advice?

February 6, 2012, University of Chicago

(Medical Xpress) -- There are ways in which patients who leave the hospital against medical advice wind up paying for that decision. Being saddled with the full cost of their hospital stay, however, is not one of them.

Insurance companies know this. who walk out may know this. But many physicians, according to a study published in the , do not.

A survey of general internal medicine doctors at the University of Chicago Medicine found that two-thirds of residents and almost half of attending physicians believe that when a patient leaves the against , will not pay for the patient's hospitalization, leaving the patient liable for the full hospital bill.

"We have all heard this, and many physicians may have passed it on to their students, even to patients threatening to leave on their own," said study author Vineet Arora, MD, associate professor of medicine at the University of Chicago Medicine. "But a closer look revealed this to be a myth, a medical urban legend, albeit a pervasive one."

"This is a misconception that we need to correct," she added. When patients leave the hospital against their doctor's advice, "that indicates a breakdown in the doctor-patient relationship."

Co-author Gabrielle Schaefer, a third-year medical student at the University of Chicago, said some physicians even will use the financial obligation angle as a threat to persuade a patient to stay. "But when a physician provides in order to influence a patient's decisions -- no matter how well intentioned -- it compounds the loss of trust," she said.

Every year, 1 to 2 percent of patients admitted to U.S. hospitals leave against medical advice. The number of patients who do this seems to be increasing: from 264,000 patients in 1997, to 368,000 in 2007, to nearly 500,000 in 2011. Studies demonstrate that those who leave against medical advice, or AMA, are much more likely to die or be readmitted within 30 days.

The researchers, all from the University of Chicago Medicine, combed through the records of more than 46,000 patients admitted to the general medicine service at the medical center's adult hospital between July 2001 and March 2010. They found that 526 patients, about 1 percent, had left against doctor's orders.

Consistent with previous studies, most of these patients had government-funded insurance, either Medicare or Medicaid (78 percent), or no insurance (14 percent). The average hospital charge was nearly $28,000, of which insurance paid on average almost $6,000. (Most patients also owe a minimal co-pay.) So leaving against medical advice brought no additional financial burden to the patient.

Of the 453 insured patients who left AMA, payment was initially denied in only 18 cases. All of those cases involved problems with the bill, not with the patient's behavior. None of those patients were denied coverage for leaving against doctors' orders.

A survey of internal medicine residents and attending physicians, however, found many did believe payment would be denied and warned patients that they could be held financially responsible if they left against medical advice.

An expanded survey found similar beliefs among residents at other Chicago-area hospitals, with more than 40 percent agreeing that they "often or always inform patients that they may be held financially responsible if they leave AMA." Consent forms for patients leaving AMA from two area hospitals warned patients about possible financial consequences.

One member of the research team -- John Schuman, MD, now at the University of Oklahoma School of Community Medicine -- followed up the published study with a less formal survey.

"I thought it important to go to the source," he wrote in GlassHospital, his health care blog. "I called the insurance companies themselves. I talked with VPs and media relations people from several of the nation's largest private insurance carriers. Each of them told me that the idea of a patient leaving AMA and having to foot their bill is bunk."

"They were glad to tell me so," he added, "as this was a rare occasion of insurance companies looking magnanimous."

The Agency for Healthcare Research and Quality and the National Institute on Aging funded this study. Additional authors include Heidi Matus, Keith Sauter, Ben Vekhter and David Meltzer.

Explore further: Surprising drop in physicians' willingness to accept patients with insurance

Related Stories

Surprising drop in physicians' willingness to accept patients with insurance

June 27, 2011
As required under the Patient Protection and Affordable Care Act of 2010, millions of people will soon be added to the ranks of the insured. However, this rapid expansion of coverage is colliding with a different, potentially ...

Uninsured receive same quantity, value of imaging services as insured in hospital, in-patient setting

January 6, 2012
Insurance status doesn't affect the quantity (or value) of imaging services received by patients in a hospital, in-patient setting, according to a study in the January issue of the Journal of the American College of Radiology.

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.