I have a question ... I haven't yet written up our birth story. All things considered it was perfect and beautiful, but there is one issue that I can't seem to reconcile. I am hoping that this community might be able to help me find some answers.
What are a patients rights around discharging against medical advice (AMA) following a hospital birth?
My home birth plan turned into a hospital induction and delivery at a facility that has a 24 hour discharge policy. I wanted to go home after the birth, but they weren't willing to budge and told us that our insurance might not pay if we signed out AMA. We called our insurance and were told they would probably pay, but that we would have to submit the claim in order to find out. We ended up staying the full 24 hours, but it has left me feeling slightly bullied and ignorant about my rights.
I am just wondering what the facts are about the implications of discharging AMA.
Or if others have experienced anything similar.
thanks!
*****
UPDATE:
I contacted the California Department of Insurance with my question, mostly because I want to know my rights in case I ever end up in a different situation and want to leave AMA. Their response is pasted below:
Thank you for your inquiry to the California Department of Insurance (CDI) regarding the referenced subject matter.
The insurance company would have to cover the birth of the child as long as it is a covered benefit. If they refuse to cover the benefit you would file a complaint with the Department of Insurance called an Independent Medical Review. Your treatment would be considered medically necessary. The main problem you may have is if you discharge yourself against medical advice any complications that arise as a result of this may not be covered or covered at a lesser benefit level. Some policies may have riders that contain language stating that if you discharge yourself and do not comply with the recommendations from your physician your policy may limit future benefits that pertain to any complications relating to early discharge. Insurance companies have to comply with Federal law and allow women to stay 48 hours after a normal childbirth or 96 hours after a cesarean has been performed. Most complications to the mother and child occur within the the initial two days after delivery and the goal is not to force women to be pushed out of the hospital too soon. I'm sure you are aware of this, but ultimately nothing can prevent you from rejecting medical care or leaving the hospital.
We hope this information has been of help. If we can assist you in the future with an insurance problem, looking for insurance or provide information you may contact us through the e-mail system or you may reach our Consumer Communications Bureau at 1-800-927-HELP.
11 comments :
I live in MN and am a nurse so am only aware of MN rules. I know that often we have said, "If you leave AMA, insurance won't pay." Have only found out recently that this is not truth. Unsure where it came from because I believe we said it, having been told it was true. I think it is said to very difficult patients who most likely don't have insurance anyway (not meaning to sound stereotypical but some things seem consistent). Am sure they will pay. Call the patient rep at the hospital and discuss this with them. PS...Have followed your blog as my daughter was on the same IVF timeline. SO delighted for you. And for us...we "got" precious Harriet :).
You know I didn't mean YOU were a difficult patient. You were safe and not at risk to go home. We have said it to patients who would be in danger of leaving without treatment. Just wanted to make sure you understood that I totally understand your feelings and think you should pursue it with the patient rep. Blessings on your baby.
It may or may not be true depending on your insurance companies policy. You do have the right to leave AMA, but the insurance company also has the right not to pay if its guideline for coverage aren't met.
I work in a sleep lab and we often have to tell patients something similiar. A Sleep Study by definition is 6 hours of recording. If the patient wants to leave after 3 hours, I tell them they have the right to end the study and go, but that I need to inform them that their insurance may deny coverage. I don't know if an insurance company has ever not paid, but we have to atleast inform the patient that it is a possiblity. So they may have been telling you the truth, and it is also very possible that they were using that to bully you. I'm sure some of my patients have felt that I was bullying them, but I always try to present it as "these are your options" so they can make an informed decision.
Sorry you felt bullied. I'm finding that seems to be common with anyone who wants to do something a little different than the "norm." My friend recently attempted a homebirth but had to be transfered to the hospital, and she also felt bullied by the nurses.
I would really like to know the answer to this as well. I'm having a midwife this time and I'm not decided on home vs hospital birth. I really want to go home right after birth. My midwife will discharge me 4-6 hours after birth if there are ZERO interventions in the birth. I know better than the count on that now, so I'm worried. I always thought I HAD to stay the 24 hours because the pediatrician wouldn't discharge the baby until then, but I recently heard someone talking about leaving AMA...
The problem is that I live in Canada. The government pays for all our health care, and I'm not worried about the paying aspect. I just don't know how it goes with taking your baby out AMA.
I am a former hospital social worker who worked on the mother-baby/L&D/NICU floors, and unfortunately I have also had my experiences with patients wanting to leave AMA. It is this commonly held misconception out there that leaving AMA can give your insurance company the option to not pay, but I never once had an insurance company refuse to pay. I echo what PP have stated--simply verify this with your insurance company.
Whenever a baby/child is discharged AMA, it was our hospital policy and child protective services mandate to contact social services to alert them of a baby's discharge AMA. So, *technically* this was CPS complaint worthy. However, as the social worker, I made an assessment of the family's situation, and I relayed this to CPS with my report. Meaning, I would say, I see no risk factors with this discharge, the family appears to have great support and resources, etc. In those circumstances CPS would just screen those referrals out. (If my evaluation of the family's situation revealed something concerning/endangering, I obviously reported that.) I only share that bit because sometimes CPS is also used as a threat to prevent moms/babies from discharging AMA.
You could have definitely said, "Nope, we're going home. I have a pediatrician's check-up this afternoon/tomorrow, and you can confirm that." and been on your merry way. Those first 24 hours are busy and exhausting, and that kind of stress is the last thing you needed added to the pile! I'm sorry you had that experience!
Lauren...Are you referring to my comments from Minnesota? I don't have any of the accounts the site asked for in leaving a reply. I am not trying to remain anonymous. I don't have a blog but have followed along through my daughter's two losses and finally a successful journey with IVF. I certainly never meant to be offensive or an "Idiot". Foxy...please delete my comments if they are offensive in ANY way at all. I only meant to help. Gail in MN
Hi Gail in MN,
Thank you for your comments. Lauren was referring to another comment that I did delete as soon as I got it. To avoid any confusion, I think I'll delete her reply as well.
I DO appreciate your words and support! and Congratulations to your family on the arrival of your grandchild - my mom is absolutely LOVING her new role as grandma to baby Q. and we are LOVING having her around to help.
THank you for reading - and please DO continue to comment whenever you like!
xoxo - Foxy
Hehe - I actually was a horrendously difficult patient! I suppose we are lucky that the staff treated us as well as they did considering how uncooperative I was... ! I have no doubt that they would have been thrilled to see us go :) In any case, the 24 hour policy is something that I will be working to change, along with a few other things that weren't aligned with best practice.
Again, thank you for your comments and congratulations on the arrival of your sweet grandbaby!
Foxy....What a huge relief. The last thing I would ever want to do is to stir up controversy on your blog. Thanks for the reply. After my daughter and her husband lost two dear babies, they began looking into IVF. I dug head first into the Internet and found blogs with so much information. Reading yours and several others was just so helpful in knowing what was ahead. I followed blogs that were close to Emily's due date and it was wonderful to share the journey together though I didn't know any of the writers. I cheered you all on from afar and was so delighted as each little new one came into the world. Anyway...am rambling...thanks again for your reply. Such a relief. Gail
I am an insurance nurse- I'm the one who decides whether to approve a claim or whether to send to the doctor to approve or deny. My specialty is psych, and I often have patients enter detox for addiction and leave AMA. I generally only send for potential denial if it is a frequent occurrence. I do work for a Medicaid plan, however, and commercial insurance is more cut-throat and a different ballgame.
Here's where I could see the most likely problem- if you end up being readmitted for a complication like developing a temperature or large increase in bleeding. Most states currently operate under the DRG system, where third party payers pay a certain number of days depending on the diagnosis. For a vaginal birth, it would be 2 days, for psych it's usually 10 days. The hospital gets that 2-day payment even if you leave at 1 day by signing out AMA. If you are readmitted the next day, and within that 2-day period, your insurance is within their rights to deny the new admission, citing that it has already paid for a 2-day stay. This is usually the only reason our doctors end up denying an admission. It depends again on your insurance- they may also deny for readmission for any complication within a week, 2 weeks, or more related to the birth, based on leaving AMA.
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