On Monday night my Fiancee was admitted to the hospital with Cellulitis, she was put on IV Antibiotics and given a saline drip. Yesterday the Infectious Disease doctor said she could go on an oral anti-botic and be discharged. The hospital DR did not agree.
Today they drew blood and said they won’t release her because her WBC is elevated and she is dehydrated. The Infectious Disease Dr, still said she can go home but the hospital DR won’t release her.
We both agree she will not improve here because she is miserable. She wants to check herself out AMA.
I feel for her mental state that is the best option but she was told in the past that if she checks out AMA that Medicare will not cover the stay. Is this correct?
What a timely question- my boyfriend was just in the hospital for the same thing- he ended up staying for 4 days. Someone billed the insurance wrong and said that he refused treatment (he did not) and Cigna consequently was not going to pay for his stay- so if I were here I would NOT sign out against medical advice no matter what.
She was thinking of refusing future treatment so they would be forced to treat her. If there was someone open at her insurance to talk to today we would call them.
The distinction, AIUI (based on a few years of hospital work), is that if you leave mid-treatment when the treatment is deemed medically necessary, they can refuse to pay for the treatment and follow-up treatment. So, for example, if you need a CAT scan but decide immediately after getting the scan that you want to leave, despite the doctor telling you that you need to wait for the results, the insurance company can refuse to pay. If the doctor in your case wants to be a dick, he can say that your fiancee was mid-treatment and that the ID doc’s advice to switch to an oral antibiotic was not appropriate for her condition, owing to the dehydration and elevated WBC.
It’s not necessarily retroactive, though- if you’d completed all your treatment and the doctor was dragging his feet about making the rounds that would result in you getting discharged, you can walk out and the insurance company would still pay.
Truthfully, you can walk out at any point- it’s not like there are armed guards. But I’d want to be clear what the hospital doc’s specific objection was, and why he felt the oral antibiotics weren’t good enough, and how he was going to document things before trying to leave.
The initial issue of the infection is being resolved and she was switched from IV to Oral antibiotics so there is no issue there.
The Hospitial’s Dr noticed an increased creatine level so now he wants her to see a kidney dr in the hospitial before he will (the hospitial dr) will release her.
She is willing to see the kidney Dr but as an outpatient. From what we understand the Hospitial Dr has no problem with the switch of antibiotics and YESTERDAY he had said if the Infectious Disease Dr said she could go home she could. Now he is baktracking on that.
I think I see where he’s going with this- was she on Amikacin, Vancomycin, or Tobramycin? If they didn’t run good fluids at the same time as one of those (which, if she’s dehydrated, sounds likely), they can do renal (reversable!) damage. Sounds like the doc may want to do some CYA before letting her go.
She was on Levofloxacin and Vancomycin. I know they were running saline at the same time. They varied it though from a high of 75 on the pump to a low of 45 when they said her legs were swelling from the saline. She does have a complicated medical history.
They lied to you. Or, to give them the benefit of the doubt, they believed the widely believed urban legend that nearly half of attending physicians and probably more residents and interns and nurses believe. But no, insurance (private or Medicare) does not deny claims for leaving AMA. It is your right to refuse care at any point in the process, as long as you are mentally competent and can convince the doctor you understand and accept the risks of doing so.
Levofloxacin (Levaquin) and its related drugs (Ciprofloxacin and many others) are industrial-strength antibiotics, and can sometimes have industrial-strength and irreversible adverse reactions. You should read up on these. I would never consent to have any drugs of this class (fluoroquinolones) unless it was the absolute last resort, and maybe not even then.
See Bitter Pills by Stephen Fried, whose wife suffered serious and irreversible brain damage after a single dose of Floxin (Ofloxacin), a related drug.
ETA: When I spent a night in the ER a while back, with an IV needle stuck in my arm, I made sure to ask the nurse what drugs she was pumping into me before she started. Okay, it was just Keflex. I was okay with that.
I did the AMA route many, many times (I discharged myself more often than did the MD).
My insurance (BSofCA) paid for services rendered.
The OP sounds like another professional opinion is indicated - if she is scary-type dehydrated, a hospital is the best place to be -unless there is an RN at home who can administer an IV.
One thing that came up is that medicare and commercial insurance have different standards for what they will and won’t pay for.
Considering how much hospital stays cost, it is absolutely irrational to check yourself out on a Sunday when the actual factual answer to your specific situation in your specific locale with your specific insurance can had 24 hours from now.
If something irrevocable like a surgery was about to happen without your consent that’d be different. But saying Waah! I want to go hoooome! seems like it could easily be a $10K mistake.
I’d trust WhyNot for the factual answer but realize that the I.D. doc is commenting from the infectious disease perspective and only the infectious disease perspective.
She seems to be dehydrated (I assume little urine output?) but her legs swell up when they up her IV rate to what is still a pretty modest rate? Her creatinine is rising?
These are not the issues the I.D. doc is looking at. I cannot make any intelligent comment about the need to be inpatient or not for those issues, or other aspects of her “complicated medical history,” but don’t interpret the I.D. doc as giving the blessing for those non-infectious disease issues either. Not an adult doc, let alone hers, but it sounds concerning to me.
Being in the hospital definitely sucks but leaving doesn’t magick away a potentially serious kidney issue that might benefit from more immediate/urgent care.
Agreed. My intent was to answer the factual question in the OP, not to offer an opinion as to whether or not the patient is making a good choice. Just don’t know enough.
My fiancee went in with cellulitis. She has had it before and is prone to it due to a compromised immune system that she was born with. Her immune system is so poor that she has to have IVIG monthly.
She will never be 100% “normal” and her primary knows this.
After she went on the IV antibiotics the infection was under control and everyone except the primary doctor in the hospital said she could be discharged with outpatient follow up. The primary doctor wanted her to stay one more day because of the infection even with the infectious disease doctor saying he saw no reason for her to have to stay.
Today when they drew her blood they noticed the creatine level had risen and the primary doctor started using that as the reason to keep her although all the other doctors on the consult said she could be discharged.
After a kidney doctor consulted he said the high creatine could be from the NSAID that she was given and if her level dropped on the next blood draw he would release her. They tested her and it had not dropped, but continued to rise slightly.
They will re-test her tomorrow but from my POV and her’s if the kidneys were affected by the NSAID then she would recover just as well at home, in her own bed and her own environment. She is not eating well at the hospital because the food options they have for a diabetic, kosher vegetarian with sensitivity to spices is limited.
If they won’t discharge her tomorrow I don’t know how she will react.
This is what I would do in the morning: Ask what will be done for me if I stay in the hospital that I can’t do at home. If the doc says he just wants to observe me, I would ask what symptoms I should watch for and promise to call if they happen. I would agree to come back the next day for another blood draw.
Without knowing anything else about your girlfriend’s history, I would say that her doc is probably concerned about fluid collecting in her lungs and causing breathing problems.
Ask the nurse if you can bring her some real food. Most people who are not NPO can eat what they want if they can get someone to bring it. Just, please, mind her kidneys and don’t bring her anything that’s off her medically prescribed diet. Nothing makes nurses crazy like the guy who just had a bypass and his wife comes in with McDonald’s.
