New Brunswick's efforts to use nurse practitioners to help alleviate the family doctor shortage may be out of step with the policies of some private insurance companies.

Eighteen new primary care nurse practitioners will be tasked with providing primary care for 18,000 New Brunswickers on the waiting list in the coming years.

But, those people, and others previously matched with NPs, should not assume private insurance companies will automatically accept a nurse practitioner's referral for physical therapy and medical equipment.

"Their policies are out of date," said Claire Betker, the president of the Canadian Nurses Association.

That's because major providers — including Manulife, Canada Life (formerly Great-West Life) and Sun Life — have agreements with some employers where nurse practitioners are not included in the definition of a primary care provider.

Patients under that coverage would still need a doctor's referral for medical equipment and physical therapy, even if they have an NP referral.

Claire Betker, the president of the Canadian Nurses Association, has been lobbying to get all insurance companies to accept nurse practitioner referrals as they would doctors' referrals for physical therapy and medical equipment. (Submitted by Canadian Nurses Association)

Betker said the role of nurse practitioners is "evolving," but the way they're viewed on paper is not keeping pace.

"I think it's probably less about throwing up a barrier and more about outdated policies being a barrier," she said.

There are more nurse practitioners as primary care providers now than five years ago, Betker said.

In 2018, there were 5,697 NPs practising across Canada. They are trained to diagnose illnesses and injuries, order and interpret tests and prescribe medications.

In New Brunswick, with 39,000 people on the waiting list to be connected with a family healthcare provider, the province will be hiring 18 NPs to staff clinics in Fredericton, Moncton and Saint John, which are to be established this summer.

Betker said New Brunswickers with nurse practitioners as primary care providers could see this barrier when they try to get coverage for things like medical supplies or devices, physiotherapy and massage therapy.

"Some insurance won't cover those supplies, those devices, those kinds of other health care services if prescribed by a nurse practitioner," she said.

People would have to pay for it themselves, or find a doctor to supply a referral instead.

"You're double-doing, actually," Betker said.

Betker said this would take a big toll on the most vulnerable, such as seniors who are injured or disabled or have chronic conditions that would require things like ostomy supplies, and on people in rural areas, who may have to travel to get a physician referral.

The worst-case scenario, Betker said, is "they would go without that device and without that therapy."

Insurance company response

CBC News asked Manulife, Canada Life and Sun Life if they include nurse practitioners in their definition of a primary care provider, and if there is an instance where a referral from an NP would not be accepted and one from a doctor would.

Manulife and Canada Life referred CBC to the industry representative, the Canadian Life and Health Insurance Association. Sun Life did not respond by publication time.

Joan Weir, director of health and disability policy for the Canadian Life and Health Insurance Association, said the responsibility of providing adequate health insurance lies with the individual insurers, as well as the employer who pays the benefits and negotiates with insurers.

Health Minister Ted Flemming announced new nurse-practitioner clinics for Fredericton, Moncton and Saint John. (Shane Fowler/CBC)

She said over the last 10 years, insurers have been more accepting of a referral from nurse practitioners.

She said when it's a negotiated union contract, there are cases where the employer has said referrals can only come from physicians. She said some employers "maybe even haven't thought about it."

She finds employers are "reluctant to update policy wording" because it's a big job and they only do it once every few years.

But she expects this gap to be filled within the next five years, as employer contracts are updated.

"It is coming up more and more for insurers," she said. "They're certainly hearing from nurse practitioners, and they're certainly hearing from employees."