Document name
Hearing Services
Document number
PRO 57/2017

Effective date: January 1, 2018

Approved date: October 18, 2017

Application: To provide administrative guidelines for approving and evaluating hearing services.

Policy subject: Health care services – general

Purpose:

To provide administrative guidelines for approving and evaluating hearing services.

BACKGROUND

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  1. Upon Workers’ Compensation Board (WCB) approval, a worker entitled to benefits under The Workers’ Compensation Act, 2013 (the “Act”) is also entitled to (Section 103):
    1. Any medical aid that may be necessary because of the work-related injury.
    2. Any other treatment by a health care provider.
    3. Any prosthetic or apparatus that may be necessary as a result of the injury, and
    4. Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
  2. The WCB is authorized to determine health care services fees (Section 104).
  3. The Saskatchewan Association of Speech Language Pathologists and Audiologists (SASLPA) declined to represent its members in discussions with the WCB. Alternatively, the Saskatchewan Hearing Instrument Practitioners Society (SHIPS) helped develop practice standards, business rules and fees for hearing service providers.

PROCEDURE

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General

  1. The Claims Entitlement Specialist (CES) or Case Manager (CM) will review audiograms, hearing aid prescriptions and completed Primary Level Authorization to Treat – Hearing Services forms to make sure the:
    1. Service relates to the work injury. If required, the CES or CM can ask for help from the Medical Officer.
    2. Manufacturer’s cost of the prescribed hearing aid (i.e., hearing instrument) does not exceed the amount listed in the current hearing service providers fee schedule.
    3. Hearing service provider and clinic have WCB accreditation.
  2. The CES or CM will notify the hearing service provider in writing if they are authorized to provide care and invoice the WCB. If the hearing service provider is authorized, the CES or CM will notify the hearing service provider to direct bill the WCB.
  3. The worker will pay all additional costs if they want an upgraded hearing aid that costs more than authorized through the current hearing service providers fee schedule.
  4. If the worker buys a hearing aid before submitting a claim to the WCB, and the claim is accepted, the WCB will pay up to the amount listed in the current hearing service providers fee schedule.
  5. Workers can see any WCB accredited hearing service provider:
    1. To receive a prescribed hearing aid.
    2. Regarding the service or repair of a prescribed hearing aid.

Evaluations

  1. WCB’s Health Care Services (HCS) will perform ad hoc file reviews to ensure quality assurance.
  2. HCS will monitor compliance with the:
    1. Service fees.
    2. Business rules.
    3. Practice standards.
  3. If audits of hearing service provider files and WCB files show that prescribed hearing instruments are not medically justified, the prescribing hearing service provider may be subject to reconciliation costs.
  4. HCS will issue letters to hearing service providers that do not comply with the service fees, business rules or practice standards. These letters will outline appropriate corrective actions. Failure to comply with these actions may result in the loss of WCB accreditation.

Complaints and Dispute Resolution

  1. Workers can report complaints of any nature to the WCB. The WCB employee receiving the complaint may refer the complaint for resolution to other WCB staff including the Manager of Health Care Services. If the complaint alleges professional incompetence or misconduct by a care provider, the Manager of Health Care Services will direct the complaint to the hearing service providers’ professional association.
  2. HCS will note all complaints and resolutions on the service provider’s accreditation file.

Policy references

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Legislative Authority

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Document History

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(1)    01 April 2019; procedure updated to link to most current hearing services fee schedule.
(2)    PRO 50/2015, Medical Fees – Hearing Services (effective 01 June 2015 to 31 December 2017.
(3)    PRO 50/2010, Medical Fees – Hearing Service Providers (effective 01 March 2010 to 31 May 2015.
 

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Complements

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