# Signing out of hospital AMA (against medical advice)



## Marielena (Nov 3, 2004)

Has anyone done this? Did you have any problems with your insurance covering the costs?

I'm just thinking ahead....I'll be delivering within the next month in a hospital and I've been told that the only way I'll be able to leave in less than 24 hours is if I sign myself out "against medical advice". My midwife said that she would do this herself







and she didn't think there would be a problem with insurance. I've called insurance, but got someone who seemed very new, although she thought it would be fine too. I think my next step will be to ask them to make a note in my account that it will be fine and to send me a copy of that.

I guess I'm just wondering if anyone has stories of doing this and if it was no problem or if their insurance did ask questions.

Thanks!


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## OnTheFence (Feb 15, 2003)

I signed one of my children out AMA. I called my attny and they told me that insurance could not legally NOT pay. They paid my bill in full. I know plenty of moms who left after a normal labor and delivery at the 12 hour mark, that is the minimum they have to stay here.


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## stafl (Jul 1, 2002)

I've signed myself out of the hospital AMA many times, one of those after my cesarean. Never have I had problems with insurance not paying (three different companies).


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## applejuice (Oct 8, 2002)

Are you signing yourself out of the hospital only, or with your newborn?

I do not know what is going on in your part of the world, but, in CA, the hospital can make the child a ward of the court if they do not want you to take the baby home. I am telling the truth...

On another thread I shared the case of a woman who had already had a written birth plan that included going home immediately after birth. This happened many years ago, but hospitals are not known as places for radical change.

Her doctor disappeared on vacation, and the written plan was gone.

Finally they told her she could go, but only after hours of argument.

Then they told her that she could not take her baby home.

More hours of argument...

Finally they told her she could go home with the baby if she signed a paper. Not an AMA, but a different form: a "Permit for Disposal of Dead Infant", form. She signed it, and left.


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## mamaverdi (Apr 5, 2005)

Clearly you are not, but OMG. This is clearly beyond the bounds to me.

One reason I have had both my children at home is because I desperately fear them being taken "hostage" by the hospital. I thought it was some irrational fear, but clearly, NOT.

MamaVerdi


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## BensMom (May 4, 2002)

Quote:


Originally Posted by *mamaverdi*
One reason I have had both my children at home is because I desperately fear them being taken "hostage" by the hospital. I thought it was some irrational fear, but clearly, NOT.

MamaVerdi

Amen! My DH is still a little worried about HB, and I don't think there is much else I can do to alleviate his little worries until the big day occurs. But he continues to say over and over how glad he is that will not have to fight the hospital to leave. They did everything they could to "force" us to stay. Too bad I did not know about AMA at the time.

Excuses started innocuous, like "we want to make sure you have established BFing first" (like they cared!) and ended up with "we will release you, but not the baby" (WTF?) Seems like thanks to the law that says that insurance companies *must* cover 48 hrs, the hospitals now consider it their God goven right to bill for exactly those 48 hrs!


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *mamaverdi*
One reason I have had both my children at home is because I desperately fear them being taken "hostage" by the hospital. I thought it was some irrational fear, but clearly, NOT.

A Reasonable Fear.


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## ZanZansMommy (Nov 8, 2003)

I was transferred with my 1st HB & I only stayed at the hospital for 3 hrs afterwards.


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## applejuice (Oct 8, 2002)

...with your baby?


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## ChristaN (Feb 14, 2003)

When my younger dd was born, my older one had just turned two & she really needed me home, so I signed myself & my new baby out AMA so that we could go home to older dd. I was GBS positive, didn't do abx during labor, and they still gave me no problem about leaving with my new one. Insurance paid in full. I guess that I didn't realize how lucky I was!


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## JoyAnne (Aug 13, 2004)

We signed out AMA in March from a Tenet hospital- I think we confused them, and the charge nurse said insurance might not pay. DH called our insurance company- they had already paid- and laughed when we asked our question- they would rather us go home and not charge them.

We just calmly requested the form to sign and packed our things. Then they were all excited about getting the PKU done- I refused (we did it a week later) and that really sent them into a tither! Anyway- we went home, insurance paid.

I think that insurance not paying if you sign out AMA is kind of an urban legend.


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## sarahloughmiller (May 22, 2004)

My doc told me that ins would not pay if I left AMA, but maybe he is just trying to get me to stay longer as that does not seem to be the case. The hospital here only makes you stay for 6 hours, which I am sure will go by pretty fast. I had ds at home and I know I will be wanting to be home ASAP, although taking a shower at the hospital will be easier so I can take up a little time doing that. I just hate to make my little babies take a 20 minute car ride 6 hours after their birth, it is so nice to just lay around the house with them after they are born.


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## ZanZansMommy (Nov 8, 2003)

Yes with my baby







They only wanted to make sure I had a carseat.


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## Marielena (Nov 3, 2004)

Thanks so much everyone!! I feel more comfortable about this now. If only insurance paid for homebirths, then I'd be all set


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## Belleweather (Nov 11, 2004)

Quote:


Originally Posted by *JoyAnne*
I think that insurance not paying if you sign out AMA is kind of an urban legend.

I think you're totally right on about this. I work for a big insurer, and we totally pay regardless of whether you're AMA. I think we'd be in trouble legally if we DIDN'T pay! In fact, there isn't even anything on the claim form that the billing people could use to indicate that you were AMA, so unless there was an inquiry for some other reason (like someone died, or it was outrageously expensive, or something like that) and they requested the full medical records I can't even figure out how your insurance would know.


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## eclipse (Mar 13, 2003)

i left after about 18 hours with dd - but they did everything in their power to try to keep me there - delayed tests, didn't tell the on call OB (who happened to be my OB) that i wanted to leave, so he assumed i'd decided to stay another night and didn't come to give me the medical all clear (he seemed annoyed about this too). i finally told them they had 20 minutes to get their shit together, ior i was walking out the door AMA. i didnt' have to actually sign out AMA, because i guess i scared them (or my OB had some words with them) and they cleared me medically.


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## gridley13 (Sep 3, 2004)

I did it once and insurance paid.

If you want to hear the story, here it is (if not please skip to next post :LOL )

I was about 12 wks pg and had exreme cramping and gushing blood. I had previous spotting in prior weeks, but nothing like this. We went to the ER and it was just like stories I had heard but never believed. The person taking my info said "You have had a previous successful pregnancy? So you at least have one good one at home?" They kept trying to catheterize me before doing anything else, including checking for a hb. I refused the catheter repeatedly. They sent a 12 year-old looking nurse to use a doppler and she did it horribly. She found nothing and said, "I hope the rest of your night gets better." Finally I saw the doctor, and after about 2 min of conversation and looking at the chart, she asked, "Oh wait... are you pregnant?!" Once she left the room, I got dressed and told dh we were out of there. I saw my midwife in the morning finally, and she found the hb in about 3 sec. My son is 13 mths today







. I am sorry I hijacked the thread... I am still mad about the event I guess.


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## Babytime (May 4, 2004)

Hmmm ... well, I was _asked_ to leave ... less than twelve hours after delivery they asked if I would like to leave the following morning, which was 24 hours after delivery. I delivered in a Boston hospital and had no problems ... they were 100% supportive of my wish for a natural birth, were strongly opposed to formula, loved that I was cloth diapering, etc. When I went on the hospital tour, there were 40 babies in the hospital at the time but only two were in the nursery because they encourage rooming in.

I guess I wasn't AMA if they suggested I leave but just wanted to share that yes, insurance paid and also that I'm shocked some people had trouble leaving! How awful!


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## crysmomofthree (Mar 18, 2004)

I signed my preemie son out of the nicu ama, after a 14 day stay because he was doing great, even the nurses thought so, but the on call ped wouldn't discharge he said we needed to wait until our ped was on (another 2 days







: ) so I said we are going home, the nurse only cared that we had a car seat, and gave us a referral for a home visit by the public health nurse
crystal


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *Marielena*
I feel more comfortable about this now. If only insurance paid for homebirths, then I'd be all set









Traveler's Insurance paid for my homebirth in 1983 - 80/20, $100.00 deductible.

Of my four homebirths, it is the only one I had health insurance for, and yes it paid...

I did not have insurance with the others.


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## Sagesgirl (Nov 22, 2001)

: Did it with my first. No one told me that I had to have someone pick me up from the hospital 'cause it's against VA law to drive for 8 weeks after a c-section. They said they wouldn't release me and I told them I was going to take my baby and go home, give me the AMA forms to sign. God, they were shocked. Sent a social worker to lecture me. Called their lawyers repeatedly to see if they couldn't at least keep Bobbie. They even sent a _chaplain_ up to my room! (Too bad for them he agreed with me.)

Of course, they weren't concerned about _me_ in the slightest. They were concerned with their own liability.







What truly pissed me off about it all was that they didn't have the balls to admit what their true concern was. (My response to "You can't drive" was "I know where the bus stop is." But of course once their lawyers found out they wouldn't be responsible for me, they were more than OK to see me drive away.)


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## danav (Jun 3, 2005)

How I wish I had KNOWN that leaving AMA would not cause the insurance company to deny payment...I have ALWAYS heard that (I worked in hospitals for 7 years before my children were born and I thought it was common knowledge!).

When Noah was born he was transferred from our birth center to Children's Hosp NICU down the street because of birth depression (he had to be resucitated and was having trouble breathing well on his own). This was late Monday night. They told us Wednesday that he would be moved out to a regular room in the hospital as soon as one opened up, which was great news because then I would be able to lay down on a bed and rest with him (I had been spending all of my time sitting in a hard rocking chair next to his isolette in NICU - not fun for the first 2 days post-partum!). Well, the hospital was full and there was no room to move him to, so they made him stay in NICU until they finally discharged him Friday night. I was so upset Thursday evening that I begged the nurse to call the doctor to ask him to go ahead and let us go home - she called him twice (I heard her on the phone so I know she did) and he refused to discharge Noah. If I had only known insurance would not deny payment, I would have walked out of the NICU with my baby right then and there - he was fine and did NOT need to be in NICU! He did develop jaundice the next day (which is what kept us there all day while they did phototherapy) but I would have caught that at home and we could have taken care of that with the pediatrician. So we spent at least 24 hrs longer in the hospital that we really needed to...







:


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## ZanZansMommy (Nov 8, 2003)

Quote:


Originally Posted by *Babytime*
I delivered in a Boston hospital and had no problems ... they were 100% supportive of my wish for a natural birth, were strongly opposed to formula, loved that I was cloth diapering, etc. When I went on the hospital tour, there were 40 babies in the hospital at the time but only two were in the nursery because they encourage rooming in.


I wonder if we gave birth at the same hospital? Sounds so similar.


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## Babytime (May 4, 2004)

Where did you deliver? My first was at Brigham and my second was at Beth Israel. I was refering to Beth Israel in my post, but honestly, both hospitals were the same. It was a wonderful experience and I am shocked when I read about people being pressured or harrassed in any way.


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## nancy926 (Mar 10, 2003)

My insurance will pay for a homebirth too.

If your insurance covers a CNM or CPM, it will probably pay for a homebirth. there's no CPT "code" for a homebirth, so the insurance company really can't tell where you are giving birth. I would think they'd be able to tell the difference between a hospital birth and a homebirth, but probably not a freestanding birth center birth and a homebirth.


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## Belleweather (Nov 11, 2004)

Our insurance will pay the midwife fees for a home or birth center birth and fees for supplies so long as the midwife purchases them, but won't pay the facility fee for a birth center, for exactly that reason -- the midwife's services are the same code no matter what, but there's no code for the birth center facility fee and it's not considered a covered treatment.


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## ZanZansMommy (Nov 8, 2003)

No my experience was at Tobey General Hospital. Glad to hear there are more MA hospitals that are open to this.


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