Insurance company denies claim because prescriber was a nurse practitioner

The CEO of Nurses and Nurse Practitioners of BC says this isn’t the first time an insurance company has rejected a prescription from a nurse practitioner.

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

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Robert and Andrea Brown, both in their 60s, did not have a primary care clinician until Andrea Brown had to go to Goldstream Primary and Urgent Care Center and was put in touch with the nurse practitioner Sarah Adair.

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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 custom-made orthotics from Andrea to relieve hip and knee pain, the insurance company said that under Brown’s plan, this type of prescription had to be written by a “physician, podiatrist, or chiropodist.”

“They say nurse practitioners aren’t covered,” said Andrea Brown, 75. “I think they should be covered.”

There are more than 800 nurse practitioners in British Columbia, about half of whom work in family medicine, according to the Nurse and Nurse Practitioners of BC

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Robert Brown, 73, has a supplementary health insurance plan that covers his wife, from the University of Waterloo, where he was a faculty member. He does not understand why Canada Life, owned by Power Corporation of Canada, would cover much more serious drugs, but not orthotics.

“It’s one of the things that’s beyond comprehension because [our nurse practitioner] wrote my heart medication certificates, 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 former employer and the insurance entity, they’re claiming they won’t pay because the script has to be written by a doctor.”

Robert Brown said he appealed, noting that “like a million other people in British Columbia, I didn’t have a doctor and probably never will,” but Canada Life rejected the appeal. ‘call.

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“Under your plan, custom-made orthotics are covered when prescribed by a physician, podiatrist or chiropodist,” the June 22 letter from Canada Life said. “As a nurse practitioner is not authorized to prescribe custom orthotics as part of your plan, we must maintain our decision to deny your application.”

A Canada Life spokesperson could not be reached for comment.

The Department of Health said on Tuesday it was “disheartened” to learn that a prescription from a nurse practitioner had been rejected. “We encourage all insurance companies in the province to recognize the ability of nurse practitioners to prescribe, in order to provide more people with the care and services they need,” the ministry said in a statement.

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Nurse practitioners are registered nurses with a master’s degree and advanced training. Paid on salary, they may work alone or with physicians and other health care professionals to provide care that includes diagnosing and treating physical and mental illnesses, ordering and interpreting tests, prescribing medications and the execution of medical acts. However, a nurse practitioner cannot certify someone under the Mental Health Act like a doctor can.

The Nurses (Registered) and Nurse Practitioners Regulation and the BC College of Nurses and Midwives establish the scope of practice for nurse practitioners.

Michael Sandler, CEO of Nurses and Nurse Practitioners of BC, said in a phone interview this week that he doesn’t understand why the insurance company won’t accept a nurse practitioner’s signature on a prescription. orthotics, adding that this was not the first time this has happened.

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“Some insurers – for reasons that remain with those insurers – do not accept a qualified nurse practitioner signature on certain documents,” Sandler said, noting that it has long been enshrined that nurse practitioners can refer to specialists.

The problem ends up being a barrier for patients, he said. “Obviously we would like some private insurance companies to follow the rules, but ultimately that’s up to them as an organization.”

Sandler said nurse practitioners in British Columbia want to expand the scope of practice for nurse practitioners, which could help alleviate situations like the one the Browns face.

“It’s a system inefficiency that we strongly advocate trying to improve, because nursing offers a myriad of solutions to some of the health care delivery issues that the system currently faces,” Sandler said.

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

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