The women who operate Northern Nurse Practitioners on Route 3 in the town of LeRay say nurse practitioners would have more patients if more insurance companies provided coverage for patients.

For example, Catherine M. O'Brien and Joan D. Hawthorne noted that insurance companies such as Excellus BlueCross BlueShield decline to offer coverage for their patients.

Dr. Arthur P. Vercillo, vice president and chief medical officer for Excellus BlueCross BlueShield, said he is a big backer of midlevel health care providers, but sounds a cautionary note.

"It's a matter of quality," Dr. Vercillo said. "We love having them as part of our panel. But we don't want to see a well-meaning nurse practitioner who goes out on his or her own, has some issues and hurts the entire program for everyone."

That's why if NPs are practicing outside a doctor's office, Excellus requires them to have a certain amount of experience working under a doctor's supervision. For example, he said, a nurse practitioner offering primary care would need 10 years' experience of working with a doctor in the same practice.

"I can respect BlueCross BlueShield for maintaining a high standard," said Seth M. Gordon, president and chief executive officer of the Nurse Practitioner Association of New York. "But you have to question those standards. You have to ask if those standards serve the patient or the shareholders of the corporation."

Barbara Zittel, executive secretary of the state boards for nursing and respiratory therapy, said it would make financial sense if more insurance companies covered nurse practitioner visits because they provide less expensive health care when compared with doctors.

"When they are reimbursed, they are reimbursed at a lower rate," she said.

Mr. Gordon said nurse practitioners are highly trained and licensed by the state.

"Studies demonstrate the care they provide is top quality," he said. "Nurse practitioners aren't trying to be doctors. They are trying to be health care providers."

BILL KEEPS STALLING

State Sen. Dale M. Volker, R-Depew, has been the primary sponsor several times of a bill, S03093, that did pass the Assembly a few years ago but has yet to pass the state Senate.

The bill says no insurer "that provides coverage for physician services shall exclude appropriately licensed and certified nurse practitioners ... an insurer shall provide reimbursement for those services ..."

"The problem is, like so many of these bills that extend the powers of people in the medical field, there is opposition from people in other groups like medical societies," Mr. Volker said from his office in Erie County. "It's difficult to extend the authorization of people who are not doctors."

He added, "A lot of it is turf."

But the senator hasn't given up on the bill and is open to compromise. "I strongly suspect we'll have to water it down," he said, "maybe making it more stringent in who oversees nurse practitioners."