insurance payment for AMA

[rohit76]

Advertisement - Members don't see this ad

Does insurance pays for the ER visit if patient decides to leave AMA?

 

[docB]

Sometimes. Depends on the insurer. There are insurers who will deny a claim if the patient leaves AMA.

 

[rohit76]

thanks doc B.
But what about medicare, medicaid?
Do they pay for the visit?
Some patients does not like to sign these AMA forms because of fear of nonpayment.

 

[EM2BE]

And what exactly happens if a patient just leaves and doesn't sign any forms saying they are leaving AMA? Not just in the billing aspect, but what responsibility does the hospital have without the forms signed? (I'm guessing the best a person can do is document every detail, but I'm sure that probably doesn't cover everything.)

 

[docB]

I don't think Medicare or Medicaid deny charges if the patient leaves AMA. I could be wrong.

As far as refusing to sign the form that really doesn't matter. What matters as far as the billing goes is the disposition assigned to the patient in the documentation. With most forms of EM documentation there's a spot at the end of the chart to check discharge, admit, AMA, deceased, etc. That dispositon is what matters for billing. Even if a person refuses to sign the form it won't help if you check the AMA box and document that you advised them not to go.

 

[Seaglass]

As an academic point, the form is legally useless. The most important thing is to document competency (can the patient understand your recommendations and the situation), to document that you discussed the risks of leaving AMA and the benefits of staying and that the patient understood them, and that you told the patient they were welcome to return for any reason. It is helpful if you have a nurse and family present for the discussion and document their presence.