Nursing provider wins payment for services to AIDS patient. Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003. 800-458-5231 ext. 5023.

Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.

Nursing provider wins payment for services to AIDS patient. Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003. 800-458-5231 ext. 5023.

AIDS Policy Law. 1995 Mar 10;10(4):3. Unique Identifier : AIDSLINE AIDS/95700214

Abstract: Blue Cross/Blue Shield of Alabama refused to pay claims for nursing care provided by Florence Nightingale Nursing Service. The Nursing Service administered care to an AIDS patient whose employer provided health benefits through a plan that covered charges for private-duty nursing but not custodial care. The Nursing Service attempted internal reconciliation, and eventually had to file suit in U.S. District Court and won. The appeals court rejected Blue Cross's claim that the Employee Retirement Income Security Act (ERISA) standard applied in this case. The court also stated the insurance company failed to show how its assessment of medical necessity was not tainted by its interest in controlling costs for the employer.

Keywords: Acquired Immunodeficiency Syndrome/*NURSING Health Benefit Plans, Employee/*LEGISLATION & JURISPRUD Home Nursing/*ECONOMICS Human Infusions, Intravenous *Reimbursement Mechanisms NEWSLETTER ARTICLE
950930
M9591279

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, Gill Foundation, the National Library of Medicine, Quest Diagnostics, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 1995. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1995. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .