Insurers Not Paying When Patients Leave Hospital Against Medical Advice is a Myth

Many physicians believe this to be true, but researchers say doctors shouldn’t use insurance to force compliance.

If you’re a physician telling patients that insurers won’t pay if they don’t follow doctors’ orders, a study says you should stop — because it’s not true.

An article in the July Journal of General Internal Medicine reported an analysis of data on 526 patients leaving against medical advice from University of Chicago hospitals from 2001 to 2010. Of the group, insurers denied 18 payment for hospital care, but this was primarily due to administrative errors such as misspelled names. Not a single claim was turned down for insurance payment because the patient self-discharged.

The authors also surveyed 51 residents and 41 attending physicians at the institution. Sixty-eight percent of residents and 44% of attending physicians said insurers would not pay for a hospital stay if a patient left against medical advice. Also, 71% of residents and 51% of attending physicians always or often told patients they may be held financially responsible for any bills related to the stay if they left against their counsel (

Research and anecdotal evidence suggest this nonpayment myth most likely goes beyond the University of Chicago. A survey of 114 residents from other institutions found 40% believed insurers would not pay if patients left against medical advice. When the data were presented as a poster at two medical meetings in 2011, numerous physicians reported to the authors that they believed this to be true.

By VICTORIA STAGG ELLIOTT, amednews staff.

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