New study counters the urban legend that insurers won't cover patients who leave the hospital prematurely

Research Activities, August 2012, No. 384

Nationally, 500,000 patients (1-2 percent) in the United States leave hospitals against medical advice (AMA) each year. Many of these patients are warned by their doctors that if they leave, they might have to pay their bills themselves. However, a recent study failed to find any hospital patient whose insurer refused to pay because the patient left against medical advice. The researchers sought to determine whether this course of action by insurers was real or represented an urban legend, primarily used to dissuade the patient from leaving the hospital. They found that, of 526 patients who left the medical center AMA over a 9-year period (1.1 percent of patients admitted during this period), insurance refused payment in 18 cases (4.1 percent), but no patient was refused payment because they left before discharge.

A silhouette depicts a patient in a wheelchair with another person standing behind the chair.

However, the researchers found in a June 2010 survey of 50 internal medicine residents and 41 attending physicians that a majority of the physicians (74 and 56 percent for residents and attending physicians, respectively) believed that insurers will hold patients who leave the hospital AMA financially responsible. Most of the physicians reported that they learned this from their peers or from case managers.

The researchers suggest that residency programs and hospitals educate physicians to give patients the proper information about insurers' response to them leaving the hospital AMA.

The researchers used data from all patients enrolled in the University of Chicago Hospitalist Study from July 2001 to March 2010, and surveyed a convenience set of internal medicine residents and attending physicians in the Chicago area. Their study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS16967) to the Hospital Medicine and Economics Center for Education and Research on Therapeutics (CERT) at the University of Chicago. For more information on the CERTs program, visit

More details are in "Financial responsibility of hospitalized patients who left against medical advice: Medical urban legend?," by Gabrielle R. Schaefer, B.A., Heidi Matus, M.D., John H. Schumann, M.D., and others in the Journal of General Internal Medicine 27, 2012.


Current as of August 2012
Internet Citation: New study counters the urban legend that insurers won't cover patients who leave the hospital prematurely: Research Activities, August 2012, No. 384. August 2012. Agency for Healthcare Research and Quality, Rockville, MD.