Consequences/Implications over "against medical advice"

A few weeks ago I was in a hospital, and my medical “team” wanted me to be transferred to a rehab hospital. I didn’t want to go because it wasn’t necessary, but they told me that I could either go there or I could discharge myself from the current hospital “against medical advice”.

I know what this means in the most general sense, but it scared me – mostly I was concerned about the possible effects on my health insurance – would follow-up care that resulted from going against their advice be covered?

At the rehab hospital, they gave me a series of assessments, decided that I wasn’t in need of any of their therapies, and discharged me the next day with no treatment at all. It was two days wasted, except that the food was better at the second place.

So, other than getting sicker or dying, are there any other potential downsides to ignoring medical advice like this?

From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378751/:

In the paper, “payment” is for the current visit, not subsequent care for the same problem. Those cases have the advantage that you can specifically confirm that in one particular case, the patient left AMA and insurance paid. The follow-up case would be harder to study, but I see no reason to believe it’s different.

Since this involves legal/medical advice, let’s move it to IMHO.

Colibri
General Questions Moderator

Well if you get sicker or if you die, you (or your family) are less likely to be successful at suing them for malpractice.

That’s certainly one I hadn’t thought of. I have to think about whether I care about that particular future – no spouse or kids to worry about.

It is the reason they are telling you this. Not because they care about you. Their lawyers make them say this to you, to reduce their risk of being sued. Majority of the bureaucracy in a hospital is to reduce their risks of being sued.

In my case I think they were a little more calculating. The rehab hospital is brand new, opened the week before I was sent there. I was the 28th patient – ever. The new hospital is a subsidiary of the one I was at, I believe they were encouraging their staff to pump new patients into it for a new revenue stream.

It shouldn’t affect your insurance, though I can’t say that for sure. But as far as I know your insurance will cover you if you intentionally set yourself on fire so I don’t see what grounds they could use to deny you care if you check out of a hospital AMA.

This.

And also, as the study linked shows, they themselves may think that if you leave AMA, your insurance may not pay for future care. And in one sense, they’re almost right - insurance companies are now routinely not paying the full cost of a readmission before 30 days. But that doesn’t mean you have to. It means the hospital is forced to eat the cost for some of the payment on a subsequent visit within 30 days, if the readmission is related to the first admission. So they really don’t want that if keeping you longer, sending you to rehab, or referring you to a home nurse will likely reduce the chances of you being readmitted.

But to you and your pocketbook, there are no worries.

I believe you’re correct, though according to slipperoku’s link above, many physicians (most?) incorrectly tell their patients that there may indeed be bad insurance consequences.

That didn’t happen to me – I imagined the insurance problems without any help from the docs.

A more common problem nowadays seems to be the insurance company pressuring the hospital to send the patient home prematurely, and then they have to come back in a few days because they got much sicker.

Here’s a thread from a few months ago on a related topic. http://boards.straightdope.com/sdmb/showthread.php?t=757133

In that thread I relate a story wherein an AMA discharge had real consequences for Medicare being willing to pay for subsequent care.

That’s…kind of a different story. It wasn’t the AMA discharge that had consequences, it was not staying the Medicare mandated amount of time. And they paid for her care, but not her room and board (small consolation, I know.) If she’d gone AMA on day four, there wouldn’t have been a problem.

Definitely worth knowing about, though. Here’s a good article about the issues: http://thehappyhospitalist.blogspot.com/2012/07/Three-Midnight-Rule-Medicare-SNF-Nursing-Home-Stay.html

I suppose it’s possible your insurance won’t cover the rehab if you change your mind later.

Rehab is being heavily promoted by the industry. They have plenty of statistics to show better long term results for people who go to rehab vs. those who don’t. But the category of those who don’t includes the people who didn’t go because they couldn’t afford it. I’d like see results between the two groups limited to just those with coverage for it.

Granted it’s a different situation. And definitely a corner case.

But I wanted to point out that some folks’ blanket “AMA discharges never have insurance consequences for anyone anywhere anytime and anyone who tells you otherwise is an evil industry stooge” statements were not in fact 100% true always everywhere.

Thanks for the link.