Appleman

John Alan Appleman appeals the summary judgment entered on the motion of National-Ben Franklin Insurance Company of Illinois (Company) which foreclosed his suit for hospitalization benefits.

Appleman underwent cancer surgery and incurred hospital expenses of $3,038.65. On receiving the bill for hospitalization, Company refused to pay saying those expenses were “not actually incurred” or Appleman was “not required to pay” because these charges were paid by Medicare.

The question here concerns how Medicare Part A payments are to be treated. The pertinent parts of the insurance contract with Company read:

Appleman says he relied on the brochure in buying Company’s insurance and the brochure said:

He points out that if these hospital costs had been paid by Blue Cross or a like insurer, Company would have paid the bill again. Appleman argues that payments from Medicare are no different.

Only a few cases have addressed the question of Medicare Plan A benefits. Appleman cites us to two: Black v. American Bankers Insurance Company (Texas) 478 S.W.2d 434 ; and Niles v. American Bankers Insurance Company (La.App.) 229 So.2d 435 . Both of these cases deal only with whether a…