Document 0615
 DOCN  M9590615
 TI    Nursing provider wins payment for services to AIDS patient.
       Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003. 800-458-5231
       ext. 5023.
 DT    9509
 SO    AIDS Policy Law. 1995 Mar 10;10(4):3. Unique Identifier : AIDSLINE
       AIDS/95700214
 AB    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.
 DE    Acquired Immunodeficiency Syndrome/*NURSING  Health Benefit Plans,
       Employee/*LEGISLATION & JURISPRUD  Home Nursing/*ECONOMICS  Human
       Infusions, Intravenous  *Reimbursement Mechanisms  NEWSLETTER ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).