Does a plaintiff have to pay for medical services provided by a private insurer when the insured has no obligation to pay?

MultiRegion, United States of America

The following excerpt is from Cedars-Sinai Medical Center v. Massachusetts Mut. Life Ins. Co., 67 F.3d 305 (9th Cir. 1995):

Health insurance is an undertaking to indemnify another for losses caused by illness. Haynes v. United States, 353 U.S. 81, 83 (1957). Because health insurance is a contract to indemnify, courts have found that insurers are not obligated to provide coverage under a policy when the insured has no obligation to pay for medical services. See, e.g., United States v. Metropolitan Life Ins. Co., 683 F.2d 1250 (9th Cir.1982) (insurer not required to reimburse hospital for free care provided to insured); Margolis v. Prudential Ins. Co., 629 F.Supp. 195, 198 (D.C.Cir.1985) (insurer not required to pay insured when medical provider has waived payment).

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