Effective date: November 1, 2011
Application: All customers requiring optometry services on and after the effective date.
Policy subject: Health care services – providers
To establish billing requirements for optometry services provided to Workers’ Compensation Board (WCB) customers.
- Section 103(1) of The Workers’ Compensation Act, 2013 (the “Act”) states “every worker who is entitled to compensation or who is disabled only on the day of the injury is entitled without charge to:
- any medical aid that may be necessary as a result of the injury;
- any other treatment by a health care professional;
- any prosthetics or apparatus that may be necessary as a result of the injury, and to have any prosthetic limbs and eyes and any surgical appliances such as belts, braces, supports and orthopaedic shoes repaired, maintained and renewed when necessary by reason of accident or ordinary wear and tear; and
- any transportation or sustenance occasioned by the medical aid.”
- Section 104(1) of the Act states “the fees for medical aid furnished by any health care professional are those that are determined by the board.”
- Section 115(c) of the Act states that the WCB may expend moneys from the fund for any expenses incurred in the administration of this Act and, without restricting the generality of the foregoing, the board may expend moneys for “any medical aid provided pursuant to this Act to injured workers and any specialized treatment or other medical aid that the board considers necessary and that is not provided for in this Act.”
- The Saskatchewan Association of Optometrists (SAO) sets the standards of practice for optometry services. SAO is responsible for licensing and regulating the practice of optometry in accordance with The Optometry Act, 1985.
- The WCB will cover the costs of optometry services, including the provision of eyewear, where it is required due to an injury arising out of and in the course of employment. Entitlement for corrective or replacement eyewear will be determined in accordance with POL 11/2016, Expenses – Orthotics/Appliances – Provision, Replacement, and Repair.
- Optometrists will direct bill the WCB for all services provided to WCB customers and will charge according to the most current rates set by the Saskatchewan Ministry of Health (www.saskatchewan.ca). Payment for all optometry services will comply with these rates.
- Where the optometrist direct bills the WCB for reporting fees, the amount invoiced will be in accordance with PRO 04/2020, Physicians.
- All optometry services, except emergency treatment, must be pre-authorized by the WCB.
- Optometrists will submit a report to the WCB indicating the type of service required, and a cost estimate based on the Saskatchewan Ministry of Health’s rates.
- Operations staff will review the report to ensure that the recommended service is related to the work injury, and the estimated costs are in accordance with the Saskatchewan Ministry of Health’s rates. Assistance may be obtained from the Manager of Health Care Services or the WCB Medical Officer.
- Where the recommended service is not noted in the Saskatchewan Ministry of Health’s rates, Medical and Health Care Services may provide advice regarding a reasonable fee that should be paid.
- Following this review, Operations staff will authorize the optometrist, in writing, to proceed with the service. The authorization will request the optometrist to direct bill the WCB for the service and amount authorized. A copy of the authorization will be sent to the customer.
- Operations staff will provide a detailed explanation, in writing, in all instances where the amount authorized is less than the cost estimate provided by the optometrist.
- Where the customer obtains emergency treatment, the optometrist will submit a report to the WCB indicating the type and cost of service provided. Following review of the report by Operations staff, and by Medical and Health Care Services where required, the WCB will process payment (if authorized) to the optometrist.
- Where the customer paid the fees for the emergency treatment, the customer should submit to the WCB copies of original receipts and the form completed by the optometrist detailing the work completed. Original receipts must be retained for 12 months from submission date, as they may be requested by the WCB for audit purposes.
- Where the fee is in excess of that determined by the WCB, the WCB will contact the optometrist and request a refund for the customer. Where a refund is not provided, the WCB will reimburse the customer and the extra billing will be recovered from WCB payments to the optometrist.
PRO 22/92 Medical Fees – Optometry
01 January 2014. References updated in accordance with The Workers’ Compensation Act, 2013
01 November 2017. Requirement for original receipts updated to copies of original receipts; however, original receipts must be retained for 12 months from submission date, as they may be requested by the WCB for audit purposes.