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Health Insurance Coverage And Leaving The Hospital Against Medical Advice

There is a huge myth being unknowingly  perpetrated against the general public when it comes to their rights and responsibilities as a patient.  It’s a myth that I can remember hearing as far back as my first few weeks of clinicals during medical school.  It was a constant presence during my residency training and even now, as a private practice hospitalist I hear misinformation being handed down day after day, month after month.

This myth is perpetrated by doctors, nurses, and therapists of all kinds.  What is this myth?  That their health insurance company will not pay for the care provided if they want to leave against the medical advice of their physician.

Will my insurance company pay if I leave against medical advice (AMA)? Yes.  They will pay.  Medicare and Medicaid pay for services that are medically necessary.  For example, if you go to the ER and the doctor recommends a CT scan of your chest and you decline, this does not mean the insurance company will deny payment for your visit to the emergency room.  This is what  the informed consent process is for.  If you have been admitted for a medical condition that requires hospitalization and your care plan meets Medicare medical necessity muster, your care will be paid for whether you leave the hospital when your physician believes it is safe or not.   Read more »

*This blog post was originally published at The Happy Hospitalist*

What To Do When Your Patient Wants To Leave The Hospital Against Your Better Judgment?

When a patient decides they are leaving against medical advice what responsibility does the physician have to their care?  When I was a resident in training, and even early on in my position as a hospitalist, I would get a call from the nurse that  Mrs Smith was demanding to leave the hospital against medical advice.  I would tell the nurse “Fine. Let her go. I’m not her father.”  I would tell the nurse to discharge Mrs Smith with no medications and leave it up to them to find follow up.

I would suspect this is a prevalent attitude for many hospital and emergency based physicians.   I’ve seen it over and over again.  And I still see it today.  Many doctors and nurses feel obliged to let grown men and women make poor decisions.    However, being a grown man or woman able to make poor decisions is apparently not enough to keep a doctor for being sued and losing that lawsuit because a patient chose to make poor decisions.   Read more »

*This blog post was originally published at A Happy Hospitalist*

When No One Wants To See The Patient: The ER’s On-Call Labyrinth

The call schedule is hidden somewhere inside!

The call schedule is hidden somewhere inside!


‘The patient was seen in the emergency department by Dr. Niemans, who is the acting hospitalist on call for Dr. Whitman’s group, who usually admit for the patient’s actual primary care provider, Emily Knight, PA, who works for  Dr. Robelo, who no longer takes call, but admits his patients to the hospitalist.

Because the patient has COPD and an acute left-lower-lobe pneumonia, pulmonology was consulted.  However, no pulmonologist is available this weekend.  Pulmonary is being covered by Dr. Albertson, pulmonologist in the neighboring city.  I spoke with Dr. Albertson about this and he told me he wasn’t taking call for our patients, and why did people keep bothering him.

The patient’s cardiologist, Dr. Rease, is being covered by Dr. James.  I spoke to Edgar, PA for Dr. James who said that as of 7am, Dr. James was trading call with Dr. Housefield while Dr. James went to his son’s soccer game, but if I had any questions I should call Dr. Housefield’s Nurse Practitioner Michael, who would be rounding for Dr. Housefield, Dr. James and Dr. Josefson, at least until soccer was over or something bad happened. Read more »

*This blog post was originally published at*

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