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Insurance firm rejects claim because prescriber was nurse practitioner

CEO of Nurses and Nurse Practitioners of B.C. says it’s not the first time an insurance company has rejected a prescription from a nurse practitioner.
Canada Life declined payment for $500 orthotics for Andrea Brown — with husband Robert — saying the prescription had to be written by a "physician, podiatrist or chiropodist."” DARREN STONE, TIMES COLONIST

A Colwood couple considered themselves lucky amid a family-doctor shortage to become patients of a nurse practitioner three years ago, but are shocked to find their ­insurance company won’t cover an orthotics bill because it wasn’t prescribed by a “physician.”

Robert and Andrea Brown, both in their 70s, were without a primary-care clinician until Andrea Brown had to visit the Urgent and Primary Care Centre in Goldstream and was connected with nurse practitioner Sarah Adair.

The couple have been reimbursed over the years for their prescription drug costs through insurer Canada Life, but when it came to a $500 bill for Andrea’s custom-made orthotics to alleviate hip and knee pain, the insurance company said that under Brown’s plan, that type of prescription had to be written by a “physician, podiatrist or chiropodist.”

“They say nurse practitioners are not covered,” said Andrea Brown, 75. “I think they should be covered.”

There are more than 800 nurse practitioners in B.C., about half of whom are working in family practice, according to the Nurse and Nurse Practitioners of B.C.

Robert Brown, 73, has an extended-health-care plan that covers his wife, from the University of Waterloo, where he was a faculty member. He can’t fathom why Canada Life — owned by Power Corporation of Canada — would cover far more serious medication but not orthotics.

“It’s one of the things that boggles the mind because [our nurse practitioner] writes my heart-medication scripts, and I got all my reimbursements for those,” he said. “And yet for this one, because of the legal wording of the contract between my previous employer and the insurance entity, they’re claiming they’re not going to pay because the script has to be written by a medical doctor.”

Robert Brown said he appealed, noting that “like a million other folks in B.C., I did not have a medical doctor and probably would never have one,” but Canada Life rejected the appeal.

“Under the terms of your plan, custom made orthotics are covered when prescribed by a physician, podiatrist or chiropodist,” says the June 22 letter from Canada Life. “As a nurse practitioner is not eligible to prescribe custom made orthotics under your plan, we must maintain our decision to decline your claim.”

A Canada Life spokesperson could not be reached for comment.

The Health Ministry said Tuesday that it was “discouraged” to hear that a prescription from a nurse practitioner had been rejected. “We encourage all insurance companies in the province to recognize nurse practitioners’ ability to prescribe, in order to connect more people with the care and services they need,” the ministry said in a statement.

Nurse practitioners are registered nurses educated at a masters level and have advanced training. Paid on salary, they can work on their own or with physicians and other health professionals to provide care that includes diagnosing and treating physical and mental illnesses, ordering and interpreting tests, prescribing medications and performing medical procedures. A nurse practitioner cannot, however, certify someone under the Mental Health Act as a physician can.

The Nurses (Registered) and Nurse Practitioners Regulation and B.C. College of Nurses and Midwives establish the nurse practitioners’ scope of practice.

Michael Sandler, CEO of Nurses and Nurse Practitioners of B.C., said in a phone interview this week that he doesn’t understand why the insurance company wouldn’t accept the signature of a nurse practitioner for an orthotic prescription, adding it’s not the first time it has happened.

“Some insurance providers — for reasons that remain with those insurance providers — do not accept the qualified signature of a nurse practitioner as it relates to some paperwork pieces,” said Sandler, noting that it’s long been enshrined that nurse practitioners can refer to specialists.

The issue ends up being a barrier for patients, he said. “We would obviously like … certain private insurance companies to play by the rules, but ultimately, that rests with them as an organization.”

Sandler said the Nurses and Nurse Practitioners of B.C. wants to expand the scope of practice for nurse practitioners, which might help alleviate situations like the one the Browns are facing.

“That’s an inefficiency within the system that we advocate strongly to try and ameliorate based on the fact that nursing offers a multitude of solutions to some of the health-care delivery challenges the system is currently facing,” said Sandler.

UBC started offering a nurse practitioner program in 2003. Four years ago, Health Minister Adrian Dix announced $115 million to create 200 more spaces for nurse practitioners over three years.

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