| HMO | Private Duty Nurse |
| Aetna US Healthcare | Covers: Private duty nursing approved by the HMO under home health, hospice, or inpatient care.
Note: Must be medically necessary and certified by participating specialist, approved by the PCP and approved in advance by Aetna. |
| Blue Cross Blue Shield | Covers: Services of a registered nurse (RN) or licensed practical nurse (LPN) when ordered by a doctor and authorized by BCBS.
Limits: Prior approval is required. Cost Sharing: Coinsurance applies. Excludes: Coverage of a nurse who is a close relative, member of your household, or a sitter. |
| CIGNA / Healthsource | Covers: Private duty nursing on a case-by-case basis when determined to be appropriate by CHCNC. |
| Doctors Health Plan | Excluded. |
| Generations | Excluded, unless ordered by PCP for medically necessary reasons. |
| Optimum Choice | Excluded. |
| PARTNERS | Excluded. |
| Coventry/Principal Health Care of the Carolinas | Covers: Special or private duty nursing when determined medically necessary through case management. |
| QualChoice | Excluded. |
| The Wellness Plan of North Carolina, Inc. | Excluded. |
| United HealthCare | Covers: Private duty nursing in any location if directed by a participating physician, approved in advance by UHC, and obtained through a provider selected by UHC.
Limits: Private duty services of a licensed practical nurse may only be used in a United HealthCare hospital when approved in advance. Limited to $5,000 per member per calendar year. Cost Sharing: Copayment applies. |
| WellPath | Covers: Special duty nursing services during inpatient admissions, only if prescribed by participating physician, and pre-approved by plan. |