There is out there a persistent urban legend – is there any other kind? – that goes something like this: if a patient leaves the hospital early or prematurely, against medical advice (AMA), they will have to pay their hospital bills themselves. Their insurance companies will not pay up.
This is, in the classic tradition of such legends, very scary stuff. To make it even worse, the patients who are considering leaving their hospital beds and going home are sternly warned about this by their own doctors. Still, nationally, a good 500,000 patients do exactly this anyway every year. They get up, get dressed and get out of there!
And guess what? According to the Agency for Healthcare Research and Quality (AHRQ), a recent study failed to find any hospital patient whose insurance company refused to pay their portion of the charges because that patient left AMA. During the course of their investigation the researchers found that, of 526 patients who left AMA over a nine-year period, insurance payment was refused in 18 cases (4.1%), but no patient was refused payment because they left before discharge.
The researchers thought about this carefully. Suppose the whole thing got started by hospital administrators who fear being stuck with huge unpaid bills by runaway patients? That’s how these legends start as a rule, as cautionary tales or protective mechanisms. While it’s not exactly a hostage situation, it is an interesting angle.
Anyway, a June 2010 survey of 50 internal medicine residents and 41 attending physicians found that most of the doctors (74 and 56 percent for residents and attendings, respectively) really believed that insurers will hold their AMA patients fully financially responsible. And most of these doctors said they learned this policy from their peers or from case managers.
Given everything else that’s going on in the healthcare world, such scare tactics are probably not the best plan. Misinformation of any kind certainly undermines trust – and if the doctor is wrong about that, what else is he or she not right about? The researchers recommended that medical residency programs and hospitals educate doctors to provide their patients with sound and proper information about a health insurer’s response to anyone leaving the hospital AMA.
The data used in this study came from records from all patients enrolled in a University of Chicago Hospitalist Study from July 2001 to March 2010. The study was funded in part by a grant from the AHRQ to the Hospital Medicine and Economics Center for Education and Research on Therapeutics (CERT) at the University of Chicago.
Special thanks AHRQ news release, August 2012.