Medical Policy

Effective Date:05/12/2004 Title:Against Medical Advice
Revision Date:11/01/2018 Document:BI031:00
CPT Code(s):None
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

We will not cover any costs for care provided for a condition that results from the enrollee’s discharge Against Medical Advice (AMA).

Medical Statement

Care resulting from a previous discharge, “Against Medical Advice”, is a serious occurrence and happens only in the rarest instances when the patient’s refusal of treatment represents a clear threat to the patient’s life or health.  In support of attending physicians and provider facilities, the health plan will not cover the care provided for a condition that resulted from the discharge AMA; the member should be informed of this during counseling regarding discontinuation of treatment. If the member signs out AMA, then the member will be responsible for any complications and care resulting from the AMA and for the bill.

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Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.

Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.