| Private Duty Nursing Care Claims Guidelines |
- Sun Life requires that a nursing questionnaire be submitted before a nursing claim can be considered for payment.
- A Special Instruction is added to the patient's file if nursing care is approved (the Special Instruction will specify the level of care and number of hours).
- The Plan will not pay for nursing services rendered in a convalescent/nursing/chronic care facility as these services should be provided or paid for by the institution in question.
- Where applicable, members are advised that expenses incurred to obtain additional medical information (i.e. referrals, statements from M.D.) are their responsibility and the Plan will not reimburse these costs, even if Sun Life requests this information.
- The Call Centre usually sends out the Nursing Questionnaire as the member calls to determine eligibility
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