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July 14, 1975

The Hospital Bill That Medicare Won't Pay

JAMA. 1975;233(2):179-181. doi:10.1001/jama.1975.03260020065032

FOR SOME time now, the intermediaries who administer Medicare have been sending notices to patients for whom payment for hospital services has been denied. It is their practice to send a mimeographed letter, unmodified and impersonal, no matter what the reason for the denial. An excerpt from that letter follows:

Medicare will cover inpatient hospital services when the patient requires treatment or necessary diagnostic studies and these services can be furnished appropriately only while in the hospital.

Since the services you received do not meet this requirement, no hospital insurance benefits can be paid for your stay.

A determination has been made that you had no knowledge nor any way of knowing that the services you received during this stay were not medically necessary. However, the records show that this hospital knew or should have known that such a service would be considered non-covered.

It has therefore been determined that