Will My Insurance Pay If I Leave Against Medical Advice?

There is this contentious issue that has been lingering for a very long time. The debate of whether your insurance company will pay for your medical cover if you leave against medical advice. There is a general belief that if you leave against medical advice and the hospital reports the same to your insurance company, then the latter will not pay for your expenses. How true are these claims? Well, we take a look at some common possibilities in the medical scene and examine the outcomes;

There are many reasons cited by patients for leaving against medical advice. Some are genuine concerns while others are just out of inter-person conflicts at the place of work. Some of the most genuine concerns cited include;

Long Queues and Slow Service Delivery-

Emergency room waiting times are increasing as a struggling economy forces hospitals to close and more people to lose the health care coverage that would have allowed them to be examined by a primary care physician in a less-hurried setting; many patients get tired of waiting and choose to leave without receiving proper care. Sometimes people leave before they are attended to by all the relevant medical practitioners. They lose interest because they are forced to wait for too long before they can be attended to. Can you blame someone for wanting to leave after waiting for more than 3 hours in line? Even if it is a serious medical condition, he/she can be excused for wanting to leave thanks to slow service delivery.

Poor quality care

Some people walk away because they deem the quality of service they are receiving poor. People cited poor service delivery and sluggish staff in other emergency rooms and ended up leaving before receiving the required medical care. Such people cannot be blamed as well. They say that it is for their own good that they chose to leave before they can be treated fully. Hospitals take advantage of such situations and say that such patients left against medical advice which is far from the truth. As a sane human being, you have a right to walk away or at least complain about a poor service received.

Financial constraints

The third genuine issue and the one I deemed more pertinent was the financial constraints. Patients without comprehensive health insurance may fear the costs associated with prolonged hospitalization or invasive tests. They can maybe manage to pay for the first few treatments but with time they realize that the bills accrued are beyond their prowess and they end up leaving before being discharged. Some patients are forced to be hospitalized for specialized treatment but because they know very well that their insurance doesn’t cover such costs, they opt to go home against medical advice just to save on their finances. Hospitals will then cite this as a breach of policy and even deem it as acting against medical advice when writing the report to your insurance company.

So, having have looked at the three genuine instances it is time to look at the possible outcomes. Will the insurance company pay in any of the above mentioned cases? The answer is yes! They will pay. Medicare and Medicaid pay for services that are medically necessary. Medical necessity is the threshold for payment. If the services you have already received were medically necessary, whether you choose to stay or leave is irrele
vant with regards to the services you have already received.

Unless your insurance has a specific policy rider that states you must comply with all the recommendations of your physician, which I doubt such a policy would dare exist, third parties simply do not pay based on whether you decide to agree or disagree with the plan set forth for your care. If you have any doubt, pull out your phone and call your insurance company from your room. As patients, we have the right to refuse the recommendations of our physicians at any time, including refusing further hospitalized care at the recommendation of our physician.

This is the truth of the matter. Never allow yourself to be victimized by rogue physicians and doctors who will want to use some irrelevant clauses and rules to extort money from you in the name of acting against medical advice. Anytime you feel like a certain policy is contradicting with your personal privacy, principles or going against your insurance policy, never hesitate to act against the recommendation of the physician. Afterwards, make a call to your insurance company and explain the same. They will advise you further and tell you of any repercussion.

The rumours and mills that insurance companies will not pay for any patient who leaves against medical advice should not intimidate you. Get to know your rights and facts right. Be on the lookout always and do not hesitate to report any misdemeanour by medical practitioners in regards to AMA (against medical advice)