We hope you saw this past e-news of July 9th entitled “Reimbursement of Client Invoices through Insurance Co’s.” Please refer to this for reference and for context to this e-news blast. Further to this most informative article, it has come to our attention that some other nurses’ groups are under the erroneous impression that health insurance companies don’t recognize their education and skills in providing health services to their clients for reimbursement of claims.
Clarifying, we’ve learned from one large insurance company about their best practice. It was explained to us that health insurance companies will use the most appropriate Regulated Health Professional who is registered under the specific health college so that a gold standard of care is provided for services claimed by plan holders. For example, in making foot orthotics; the most qualified health practitioner falls under the College of Chiropodists of Ontario. A chiropodist can delegate a nurse to make them, but invoicing for services is by the chiropodist.
For Acupuncture services, the most qualified health practitioner is registered under the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. A nurse’s training in acupuncture is insufficiently deep and broad as the training required of those under the TCM college. A Nurse may have the level of skill, but not recognized by the college, therefore lf you wish to do these adjunct therapies GET REGISTERED WITH THE APPROPRIATE COLLEGE.
For nurses to be covered providing products, like compression stockings, a doctor’s or Nurse Practitioner’s prescription is needed. Where there is more flexibility on which health practitioner can provide a service, clients would need to have supplementary health insurance called a Personal Spending Account or Health Spending Account. See https://www.sunlife.ca/workplace/en/group-benefits/health-and-wellness-solutions/spending-accounts/ and click on each of these account types for comprehensive descriptions.
With all of this in mind, it still comes down to the Employer and the specific benefits they wish included on their plan. For example, foot care by nurses may be accepted, but on certain plans, only for diabetic foot care is allowed. There is no professional slight intended against nurses providing other kinds of medical foot care. The specifics will be in the detailed contract of a plan and your client may have to contact their provider to see if your services are covered to be sure.