Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

1University of Chicago, Chicago, IL

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 102


Every year, 1%‐2% of hospitalized patients leave the hospital against medical advice (AMA), placing them at risk for increased readmission and 30‐day mortality. Although 1 prior emergency department study suggested clinicians often counsel patients leaving AMA that insurance will not pay for their care despite the contrary, it is unclear if this occurs for hospitalized patients. This study aimed to assess whether insurance does not pay when hospitalized patients leave AMA and whether hospital physicians discuss this with their AMA patients.


We analyzed billing and chart data from a large ongoing study of hospitalized medicine patients to identify AMA patients. Demographic and disease characteristics of AMA patients were compared with non‐AMA patients. For all patients who left AMA between July 2001 and November 2009, insurance claims data were reviewed to ascertain if payment was denied and the reason why. Residents and attendings were surveyed to determine their perceptions of financial responsibility and how they counsel patients when they leave AMA.


From 2001 to 2009, 526 hospitalized patients (2%) left AMA. Like prior work, AMA patients were more often male (54% vs. 39%, P < 0.001), African American (87% vs. 73%, P < 0.001), and admitted with sickle cell disease, HIV, or tobacco or substance abuse. Of the 453 AMA patients with insurance (86%), payment was denied in only 18 cases (4%). Reasons for denial were untimely bill submission, incorrect name or date of birth, and admission classified as ambulatory or within 72 hours of prior hospitalization. Payment was never denied because a patient left AMA. Seventy‐four percent of residents (51 of 69) and 56% of attendings (41 of 73) responded. Many residents (68%) and attendings (45%) believed that insurance companies do not pay for hospital care if a patient leaves AMA. Also, most residents (71%) and attendings (51%) reported often or always informing patients leaving AMA that they may be held financially responsible. Attendings who believed insurance will not pay were more likely to inform patients they will be held financially responsible (Likert mean, 4.2 believe vs. 1.7 don't believe; P < 0.001). Similar results were noted for residents. Most physicians reported “learning” insurance may not pay if patients leave AMA from residents (61% residents, 24% attendings) and case managers (35% residents, 36% attendings). Although this may reflect a single institution “myth,” a recent anonymous poll of more than 100 residents from nearby institutions document otherwise (44% believe insurance does not pay; 47% counsel patients they may be financially responsible).


Despite evidence to the contrary, many hospital physicians believe and incorrectly counsel patients that insurance does not pay if they leave AMA. Although a larger study is needed, hospitals need to ensure that doctors, including hospitalists, and case managers are educated appropriately to prevent misinforming patients.


G. Schaefer ‐ none; J. Schumann ‐ none; H. Matus ‐ none; K. Sauter ‐ none; D. Meltzer ‐ none; V. Arora ‐ none

To cite this abstract:

Schaefer G, Schumann J, Matus H, Sauter K, Meltzer D, Arora V. Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 102. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed November 22, 2019.

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