Last year, a benefits plan member in British Columbia was shocked when his insurance provider rejected an orthotics claim because the prescriber was a nurse practitioner rather than a “physician.”

In the story, reported by the Victoria, B.C.-based Times Colonist, the chief executive officer of Nurses and Nurse Practitioners of B.C. said it wasn’t the first time an insurance company rejected a prescription from an NP.

It’s concerning, given that one in five Canadians don’t have a family doctor, according to a new survey by the Angus Reid Institute and the Canadian Medical Association. In fact, the Nurse Practitioner Association of Canada says there are currently 9,235 NP licenses held in Canada.

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In addition to writing prescriptions for medications, NPs can write prescriptions for medical supplies and devices, as well as for other health-care services like massage therapy and physiotherapy, says Sylvain Brousseau, president of the Canadian Nurses Association. “Nurse practitioners provide comprehensive care and have the ability to reduce the burden on the health-care system.”

In light of this shift — and the fact that 66 per cent of insurance plans sold in Canada are group plans, according to the Canadian Life and Health Insurance Association — should insurance companies be updating their policies to ensure benefits plan members can make claims for any treatment provided or prescribed by an NP?

According to the Times Colonist article, the plan member in B.C. has an extended health-care plan from the University of Waterloo where he was a faculty member until he retired. The university’s benefits provider is Canada Life.

While Canada Life declined an interview with Benefits Canada, a spokesperson sent a general statement, though it didn’t address the case in question. “We recognize the value, expertise and access that nurse practitioners bring to Canada’s health-care system. Drugs prescribed by nurse practitioners are covered under our plans and some disability leaves can be endorsed by nurse practitioners.”

Going a step further, the CLHIA directed Benefits Canada to its orthotics reference document, which states: “most insurance companies and benefits plan administrators will only accept prescriptions for custom-made orthotics from practitioners who are trained to diagnose and prescribe orthotics and who have medical training in problems related to the foot. These individuals generally include medical doctors, orthopaedic surgeons, chiropodists and podiatrists, but may also include chiropractors and physiotherapists.”

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Looking more broadly at the inclusion of NPs in insurance policies, many insurers are making headway. A spokesperson at Manulife confirmed its polices are updated with regards to NPs. “We administer claims where the primary treatment provider is an NP in the same way as if the primary treatment provider were a [general practitioner.]”

Similarly, a spokesperson at Medavie Blue Cross said the insurer works to provide plan members with access to care through the use of a variety of health-care practitioners “providing care within the limits of their professional scope of practice governed by their regulatory body, if applicable.

“With a focus on improving the well-being of Canadians, Medavie Blue Cross recognizes the vital role nurse practitioners play in creating access to health care for our members and, in many cases they are the primary care provider for many Canadians. Medavie Blue Cross accepts prescriptions and referrals from nurse practitioners for drugs and for the use of a member’s extended health-care benefits that require a prescription.”

Since Beneva was created in December 2020 through a merger between la Capitale Insurance and Financial Services and SSQ Life Insurance Co. Ltd., not all of the contract language is aligned, but it will be later this year or in 2024, says Éric Trudel, the insurer’s executive vice-president and leader of group insurance.

However, he says the current language reflects what’s legally allowed, so in the case of a drug prescription, the language is clear the plan will cover a prescription written by a “health professional,” a term that covers NPs.

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In addition, the coverage also depends on an NP’s specialty. “Let’s say a nurse practitioner who specializes in psychological health prescribes orthotics, then it isn’t the right qualification to prescribe orthotics,” says Trudel. “But most of the time, if it’s prescribed for the right specialization of the nurse, it’s accepted.”

Last year, Beneva also announced it will no longer require a prescription for paramedical services, like chiropractors, massage therapists or physiotherapists, which he calls an important step in reducing the administrative burden on health professionals.

Indeed, the CLHIA said the industry doesn’t want to add to physicians’ paperwork, requiring them to write prescriptions that NPs are eligible to write. And the association noted the industry has been updating policies over the last decade.

“For instance, [long-term disability] and [short-term disability] standard forms have been changed to recognize the role nurse practitioners play in many jurisdictions and many insurers do not require prescriptions for some [extended health-care] services at all on their standard plans.”

The Canadian Nurses Association is encouraged to see provincial and territorial governments investing in NPs to increase access to primary care providers, says Brousseau. “And that’s why we must reduce these barriers. All private insurance plans must support and reimburse patients, even when they see a nurse practitioner.

“We’re calling on all health insurance companies that provide private health insurance plans in Canada to amend their policies and language to reflect the legal scope of the practice of nurse practitioners.”

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