Insurance policies falling behind as nurse practitioners gain importance

by Leo Almazora12 Feb 2020

Faced with an extreme shortage of doctors, the province of New Brunswick is turning to nurse practitioners to help tens of thousands of people who need primary care. But those efforts may be hampered by some private insurance policies that have yet to keep pace.

“I think it's probably less about throwing up a barrier and more about outdated policies being a barrier,” Claire Betker, president of the Canadian Nurses Association, told CBC News.

According to the news outlet, nurse practitioners are not included in the definition of a primary care provider laid out in agreements between major providers such as Manulife, Canada Life, and Sun Life and some employers.

In the case of patients with that coverage, the insurer would not recognize an NP referral for necessary medical treatments or supplies. They would still require a doctor’s referral — a significant hurdle for 39,000 New Brunswickers on a waiting list to be connected with a family healthcare provider.

As reported by CBC News, 5,697 NPs were practicing across the country as of 2018. Aside from being trained to diagnose illnesses and diseases, they can order and interpret tests, and prescribe medications. They may also recommend physiotherapy and massage therapy, as well as medical supplies or devices.

“Some insurance won't cover those supplies, those devices, those kinds of other health care services if prescribed by a nurse practitioner,” Betker said. “You’re double-doing, actually.”

According to Betker, having to pay out-of-pocket or find a doctor to supply the referral would be a significant toll on the most vulnerable patients. Those include seniors who are injured or disabled, those with chronic conditions, and people in rural areas who may not have immediate access to physicians.

CBC said it reached out to Manulife, Canada Life, and Sun Life, asking about their policies on including nurse practitioners under the definition of a primary care provider, and whether they in some cases would honour a doctor referral but not one from an NP.

Manulife and Canada Life referred the questions to the Canadian Life and Health Insurance Association, while Sun Life reportedly did not respond immediately.

Speaking for the CLHIA, Joan Weir, director of Health and Disability Policy, said that individual insurers and employer sponsors share the responsibility of providing adequate health insurance. She added that insurers have grown more accepting of NP referrals over the last decade.

She acknowledged that some negotiated union contracts allow only physician referrals, as some employers are “reluctant to update policy wording,” preferring to tackle the challenge once every few years. However, she expects the gap to be filled as more employer contracts are reviewed and amended.

“[Insurers are] certainly hearing from nurse practitioners, and they're certainly hearing from employees,” she said.