In all the years that I’ve been reading and writing about health insurance, I had never heard of the idea that patients could be held fully responsible for their total hospital bill – despite having health insurance in place – if they left a hospital against medical orders. But this article indicates that such a notion is widely believed by doctors, and a lot of them will use the idea of a financial penalty to try to dissuade patients from checking themselves out of the hospital against the doctor’s orders. Interestingly enough, the vast majority (78%) of the patients in the study who checked themselves out of the hospital against medical orders were covered by public health insurance – Medicare or Medicaid.
It seemed odd to me that this myth is so widely believed among physicians. Perhaps it’s because they are sometimes on the receiving end of not getting reimbursed for care if certain medical mistakes are made. CMS came up with the idea of “never events” – and private health insurance companies are following suit – and basically created a list of medical complications and errors that they say should never happen. If they do, the hospital and doctors involved still have to provide care for the patient to remedy the problem, but they don’t get paid for it. And they can’t hold the patient responsible for the non-reimbursed care either.
I’m sure most physicians are aware of the “never events” list. From their perspective, a patient who leaves the hospital against medical orders is absolutely making a medical mistake – one that is likely to be costly both in terms of the patient’s health and in terms of additional care that will be needed in the future. Maybe the doctors assume that just as health insurance might not reimburse providers for care when a medical error is involved, perhaps the carriers will deny payment if the patient makes an error – in this case, acting against medical orders.
None of that is true however. As long as the treatment provided is a covered service on the patient’s health insurance plan, and as long as any required pre-authorization was taken care of, the health insurance carrier does not withhold payment simply because the patient acted against medical orders and checked out of the hospital. This is also true of other forms of non-compliance: for example, patients who don’t fill their prescriptions or those who resume activity too soon after surgery will generally find that their health insurance still covers their bills according to the language of the contract.
If “never events” on the patient end of the scale were cause for claims denials, I have a feeling that there would be a lot more denied claims. Health insurance carriers can and do charge higher premiums for various choices people make (like smoking, for example). But once a policy is in force, and premiums are paid on time – and assuming the application was completed honestly – the coverage is usually not dependent on the patient following doctors orders.