I Signed an AMA to leave ER after cat scan found nothing - will Medicare pay for it?

A fellow caregiver asked...

I fell in the house and struck my head - taken by ambulance to ER - after blood tests indicated one elevated Heart enzyme, a CPK TOTAL OF 533 (i have peripherial neuropathy and have 2 heart stents) and I am taking crestor (I had the same thing happen when I was taking Lipitor for High Cholesterol and I had to be taken off it for 3 mos.) The muscles are deteriorating in my legs because of it -- After a cat scan and heart x-ray the doctor said they were both clear - no concussion nor anything negative on the EKG. She said she wanted me to stay to observe - I felt better and wanted to go home. She had me sign a paper (which I couldn't read the small print) and said it was an AMA - she nor anyone else indicated it would be a problem with my medicare - nothing. I went home -- the next evening I had problems with my other eye - I could not detect colors - seemed all grey with the eye where I fell was fine. Went back to the ER - did another cat scan and blood tests ...... no concussion and blood tests were the same -- when they finished, I had the color vision return to my eye - they wanted to observe again - Labor Day weekend - no one around - I signed another AMA and went home. I live alone - vision has returned to normal as the blood has drained internally - am scheduled to see my Cardiologist on Monday (2 days). I was told by a nurse friend that because I Signed an AMA 2xs that Medicare would not cover the cat scans, the xray, the blood tests or anything else - I am 70 and on a fixed income - I am financially concerned that Medicare won't pay -- No one in the hospital ever advised that Medicare would not pay if I signed an AMA - and there was no way I could read the fine print -- What is the truth - I needed the help at the time - but didn't want to stay in the hospital since they could find nothing -- What should I be prepared for??? Please help me

Expert Answer

The document you signed twice upon leaving the emergency room is called an Against Medical Advice (AMA) release form. Generally, it has nothing to do with Medicare coverage. Instead, it is a document to protect the hospital and the doctor from a lawsuit by you if your condition worsens after leaving and you claim that the hospital should have kept you there and given you further treatment. The AMA document says that you were advised that the doctor and hospital thought that you should remain in the hospital but that you voluntarily chose to leave against their advice.

Signing the first AMA form should have no effect on Medicare Part B coverage for your first emergency room visit and the tests that were performed then. As long as your visit to the ER was appropriate and the tests considered medically necessary given what you told the doctors there about your injury, Medicare should cover it all despite the fact that you left the hospital before the doctors advised you to. Leaving the hospital does not change the fact that the treatment and testing you received were medically necessary and therefore covered by Medicare.

The same should be true of your second visit. If your change in condition -- problems with the other eye -- from the time you left the hospital required you to again visit the ER, then Medicare should cover any medically appropriate tests to respond to that change in condition. The only thing Medicare might object to is whether the tests you received on the second visit were somehow a duplication of the tests you received the first time you were in the ER, and therefore were not medically necessary. But Medicare would have to argue that remaining in the hospital instead of going home after the first ER visit would have meant that the second round of tests would not have been performed, which does not seem very likely.