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Does insurance pay when you leave the hospital AMA?

The more I read about women birthing in hospitals, the more stories I read of women who are lied to and threatened.  It is really eroding my confidence in doctors and hospitals.  You can read two examples here and here.  If we can’t trust what they say, how can we trust when they tell us that we need a cesarean?  You do that by knowing the three types of care providers.  There are great OBs out there, like this one and these guys.  You just need to know where to look.

Here is an email from a home birth midwife, shared with permission, detailing yet another experience of doctors lying.

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.

Linda Johnson, CNM
Temperance, MI

And a reply:

Nope, untrue. When the claims are submitted to the insurance company they include procedure codes, diagnosis codes, and charges. There is no place on the forms for whether the patient was AMA or not. And quite honestly, the insurance company doesn’t really care. If the patient received less care (and therefore is charged less), most insurance companies aren’t going to blink about that at all.

I want to add, the hospital WANTS to get paid, and they know if you have
insurance they’re more likely to get paid than if you’re stuck with the bill
(as an insured person). They’re not going to do anything to make the
insurance company less likely to pay.

I found this, which isn’t specific to pregnancy, but is worth looking at.

The only thing I keep seeing as I read more is that an insurance company
might refuse to pay if you are readmitted for the same problem later on.
Which, again, I don’t really see happening, as some stats I have seen say
12% of all patients who are discharged by doctors end up readmitted within a
month anyway. Unless the doctor calls the insurance company and tells them
not to pay. Which I don’t see happening.

Does anyone have experience with this happening?

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3 comments to Does insurance pay when you leave the hospital AMA?

  • Cynthia

    When I was pregnant with my daughter in 04 I was 1 week overdue and at that visit was already 3 cms so I was ‘forced’ to go to L & D for a BPP and then to be induced since “no one wants you walking around with a partially dilated cervix”. After a good cry and pep talk with my doulas I refused the induction and had to sign AMA forms for that…the main OB on the floor came in and said I HAD to come in that friday ( 41w6d) to be induced or my insurance would/could refuse to pay for the birth later…ESP if anything went wrong ( she started citing statistics on stillbirths going up after 42 weeks and such). Not fun. Totally untrue of course, but I didn’t appreciate the stress.

  • Does anyone know if postponing a surgery AMA will affect insurance coverage?

    Beckie, I don’t know. Can anyone else help? Thanks, Jen

  • Beckie: I think it is technically true that an insurance could refuse to cover a surgery if you go AMA, though I haven’t heard of this actually happening. What I have seen is insurances refusing to cover a hospital stay, especially at an out-of-network hospital, if you sign out AMA. They use the argument of “medical necessity” to get out of paying. If you refuse a surgery, then it must not be medically necessary. This wouldn’t apply if you were getting a second opinion or looking into other options, and would require your doctor documenting well the reasons for your refusal, so you need him/her on your side.

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