When a patient leaves AMA they are often denied coverage for the visit by their insurance companies. I never ran into this in residency (or I was never aware of it) but it has become a big problem in private practice. We all se patients who come in, get a work up, but then don't want to be admitted. I can understand that and to be honest I like the patients who don't want to be in the hospital better than the ones who would live there if they could. The problem is that I am seeing patients who don't want to stay and don't want to sign AMA because they don't want to bear financial responsibility. Sometimes I just document that they were offered admission and refused but I don't make them sign AMA. This fixes their financial problem but it puts me at risk. This all or nothing scheme by the insurance companies reminds me of the time when if someone wanted to AMA they were unhooked and thrown out of the ER with nothing. Now we treat up to the limits placed by the patient. Eg. A chest pain that wants to AMA goes with ASA, NTG and is told that they can come back at any time. It's unethical to slam the door on a patient just because they won't agree to everything. This insurance policy is just as unethical.