title: Financial responsibility of hospitalized patients who left against medical advice: medical urban legend?
abstract: BACKGROUND
  Physicians may counsel patients who leave against medical advice (AMA) that insurance will not pay for their care. However, it is unclear whether insurers deny payment for hospitalization in these cases.
  
  
  OBJECTIVE
  To review whether insurers denied payment for patients discharged AMA and assess physician beliefs and counseling practices when patients leave AMA.
  
  
  METHODS
  Retrospective cohort of medical inpatients from 2001 to 2010; cross-sectional survey of physician beliefs and counseling practices for AMA patients in 2010.
  
  
  METHODS
  Patients who left AMA from 2001 to 2010, internal medicine residents and attendings at a single academic institution, and a convenience sample of residents from 13 Illinois hospitals in June 2010.
  
  
  METHODS
  Percent of AMA patients for which insurance denied payment, percent of physicians who agreed insurance denies payment for patients who leave AMA and who counsel patients leaving AMA they are financially responsible.
  
  
  RESULTS
  Of 46,319 patients admitted from 2001 to 2010, 526 (1.1%) patients left AMA. Among insured patients, payment was refused in 4.1% of cases. Reasons for refusal were largely administrative (wrong name, etc.). No cases of payment refusal were because patient left AMA. Nevertheless, most residents (68.6%) and nearly half of attendings (43.9%) believed insurance denies payment when a patient leaves AMA. Attendings who believed that insurance denied payment were more likely to report informing AMA patients they may be held financially responsible (mean 4.2 vs. 1.7 on a Likert 1-5 scale, in which 5 is "always" inform, p < 0.001). This relationship was not observed among residents. The most common reason for counseling patients was "so they will reconsider staying in the hospital" (84.8% residents, 66.7% attendings, p = 0.008)
  
  
  CONCLUSIONS
  Contrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed.
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA.
authors.forename: Gabrielle R
authors.initials: GR
authors.lastname: Schaefer
authors.forename: Heidi
authors.initials: H
authors.lastname: Matus
authors.forename: John H
authors.initials: JH
authors.lastname: Schumann
authors.forename: Keith
authors.initials: K
authors.lastname: Sauter
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vekhter
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D037001:Directive Counseling; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007087:Illinois; D007348:Insurance, Health / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D010350:Patient Credit and Collection / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data*