Choosing to Leave the Hospital Against Medical Advice

What you need to know when leaving the hospital early

Leaving against medical advice. Getty Images Credit: Huntstock

Most of the time, doctors and patients agree when it's time to be discharged from the hospital. However, there are some circumstances when there is disagreement.

Sometimes, an insurance company or another payer may disagree with a prolonged hospital stay. They may deem that the patient’s time is up and that they will no longer pay. In that case, a patient or the provider can file an appeal to the hospital discharge decision.

At other times, the situation is just the opposite. The patient may feel like they're ready to leave, but the doctors don’t believe that the patient is ready to go. If the patient does indeed walk out the door, it will be labeled a "discharge against medical advice" (DAMA).

Why Hospitals Want Patients to Stay

We would like to think that doctors and other hospital personnel have our best health and medical interests at heart when they insist we stay in the hospital, and many do. However, there may also be times when the “requirement” to stay is more about money than the patient’s health.

One reason may be that the longer you stay, the more money the hospital makes. That is, as long as they can be reimbursed either by your insurance, another payer, or you. 

Another questionable act is that the longer you stay in the hospital, the more things they can do. For example, they might order extra procedures, extra tests, and so forth.

Not all of these may be essential, but they will incur additional costs.

Yet another reason came into effect with the Affordable Care Act, which includes a system called the Hospital Readmissions Reduction Program (HRRP). It penalizes hospitals if Medicare patients are readmitted within 30 days of their discharge.

This was designed to ensure that patients are not released before they're healthy enough to go home in order to prevent them from coming back.

Why You May Want to Leave AMA

Leaving a hospital against medical advice (AMA) is not a decision to take lightly. Though there are a number of reasons you may begin thinking about it.

One common reason is that you may feel like you can no longer afford to stay. For example, if you have very high deductible health insurance or are paying cash, you may want to reduce the cost of your hospitalization. Before you assume that you can't afford it, ask the hospital’s patient advocate, patient representative, or ombudsman about the actual costs. In some cases, it may not be as much as you think.

You may also be fearful that staying longer will have a negative effect on your health. Hospitals can be dangerous places and drug errors and infections can occur. Of course, there are major benefits to staying the hospital for the amount of time needed. The problem crops up when you and your doctors disagree on what is “needed.”

Some people have also had a bad hospital experience and would prefer to leave if the situation doesn't seem "right." For example, you may feel like careless mistakes are being made that may endanger your health or even your life.

Hospitals and doctors are held accountable for situations called "serious reportable events" (SREs). In most instances, you do have choices on where you can receive care if you feel safety is compromised at your current hospital.

Before you decide to leave AMA to the detriment of your health, you may instead want to ask someone to advocate for you until it’s time to be discharged. A family member, a friend, or even a private, professional health advocate can be a vigilant voice for you while you heal.

What You Need to Know About DAMA

If you want to leave, you can. Just like most patients can refuse medical treatment, most patients can leave the hospital when they want to, too.

 It’s not illegal and it's your choice.The exception, in many cases, is with mental health patients for whom the rules and laws differ.

Try to work out the problems. Depending on what has occurred to make you want to leave early, there may be people who can help you. Doctors, hospital patient representatives, and others may be able to solve the problem if you voice your concerns.

Don’t make the decision alone. In particular, if your hospitalization includes treatment with any sort of pain medications or sleep-inducing drugs, or if you feel very sick or just not “yourself," then this decision is too important to make on your own. Ask your loved one or a private advocate to guide you in making the decision. It’s not one to make when your mental and emotional faculties are not at their optimum point.

You will be asked to sign a document. This will state that you understand that you are leaving against medical advice. Every hospital has its own form and it can be intimidating, which is why it's best to review it with someone you trust as well.

There may be all kinds of disclosures included in the paperwork, so be sure to read it carefully and understand it well. It will likely include what you're responsible for and what the hospital is not responsible for in regards to your health, billing, and any legal obligations.

Your insurance will likely still pay for the care you received. Hospital personnel may tell you that you will be required to pay for your stay. However, studies have found that leaving AMA had no effect on insurance payments for your care. To be on the safe side, check with your insurer before you leave the hospital.

Before You Leave AMA

Just because you choose to leave early does not mean that the discharge process should be abbreviated. It's still very important that you ask the right questions and get the information you need before you go out the door.

Do your best to keep the process respectful and try not to lose your temper or get too frustrated. Hospital personnel may desperately try to keep you there and they are just doing their jobs. Just as you will be respectful to them, you should ask for respect from them as well.

A Word From Verywell

Before you decide to leave the hospital, do your best to assess the risks and rewards of choosing to leave AMA. Talk to your family or an advocate about why you think it's best and get their perspective on the situation. Above all else, remember that your health is most important, though you do have the right to choose to leave if you feel that's best.

Source: 

Alfandre D. Reconsidering Against Medical Advice Discharges: Embracing Patient-Centeredness to Promote High Quality Care and a Renewed Research Agenda. Journal of General Internal Medicine. 2013;28(12):1657–1662.

Centers for Medicare & Medicaid Services. Readmissions Reduction Program (HRRP). 2017.

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