Don’t get me wrong, there are great hospital-based providers out there, but it can be really hard for your everyday mom to be able to connect with them. Generally, care providers can be broken down into three categories. There may be a supportive provider in your area, you just need to know where to look.
Here is an email from a home birth midwife, shared with permission. In this case, parents were told that if they didn’t comply with the doctors recommendations, and left the hospital against medical advice, their insurance would not pay:
Short version: had a postpartum transport last night and since baby was born OOH [out of hospital] and was a nice healthy 9#, parents had a difference of opinion with the hospital staff about how much input, if any, the hospital would have in baby’s care.
Deciding that staying would be one long argument after another, the parents decided to sign out AMA if the hospital wouldn’t budge on what they wanted to do.
The thing that almost made the parents cave was the OB’s comment that if they left AMA [against medical advice] the insurance could (actually would) refuse to pay for care mom had received.
My understanding is that insurance will pay for the care rendered, but if a patient signs out AMA, the insurance can decline/refuse to pay for subsequent care needed.
Comments or suggestions of where to find this answer.
BTW: a very kind nurse stepped into the situation and convinced the nurse supervisor to compromise.
When I looked into this, I found this 2010 article from Emergency Physician’s Monthly which stated, “Fifty seven percent of all health care providers (and probably just as many patients) believe that if you leave the hospital or the emergency department against medical advice, insurance companies will not pay for the visit. Half of doctors surveyed have told or would tell patients that insurance would not pay the bill if they left AMA.”
Yet, a 2010 study examined how 104 AMA insurance claims were processed by 19 insurance companies and found that each and every one of them was paid. They concluded, “Our study suggests that insurance companies not paying for ED [emergency department] visits of patients leaving against medical advice is a myth. ” (Wigder, 2010)
This article from the American Medical News cites another 2014 study reviewing the claims of 526 people who left AMA. The only claims that were not paid were due to administrative errors. “Not a single claim was turned down for insurance payment because the patient self-discharged.”
Why does this happen? American Medical News suggests, “People who investigated the issue suspect the myth emerged out of a desire to persuade patients to do what physicians believed was best. Eighty-five percent of residents and 67% of attendings said they told patients this information ‘so they will reconsider staying in the hospital.'”
So while it can be quite persuasive to hear that your insurance will not pay if you leave AMA, it’s simply not true.
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