Audiology

Information for Audiologists

ReturnToWorkSA is committed to ensuring workers have access to high quality services to assess and treat their noise induced hearing loss. The insurer, ReturnToWorkSA or a self-insured employer, requires the audiology practitioner to be:

• registered with ReturnToWorkSA to provide the services;
• a ‘Full Member of Audiology Australia who holds a ‘Certificate of Clinical Practice’ issued by Audiology Australia; OR
• either a Full/Ordinary or Fellow Member – Audiologist or Audiometrist of the Australian College of Audiology; OR
• either a Full or Fellow Member Audiometrist of the Hearing Aid Audiometrist Society of Australia.

Service Expectations

Audiologists are expected to meet the Service Standards set out in the Return to Work Act 2014.

An audiologist must not provide advice to the patient about the compensability of their noise induced hearing loss.  Audiologists should direct their patient to their employer or to ReturnToWorkSA on 13 18 55 to discuss lodging a workers compensation claim.

Workers do not need to obtain legal representation to lodge a workers compensation claim. However, where a worker is dissatisfied with a decision of ReturnToWorkSA they may seek legal representation of their choice.

An audiologist must not direct or refer the patient to further treatment without first disclosing any business relationship with that service and advising the patient that they have choice in who they select for assessment and treatment services.

How much the insurer will pay

A fee schedule and policy, published by the Minister for Industrial Relations in the South Australian Government Gazette establishes the gazetted fees which are the maximum fees chargeable.

All services must be delivered face to face unless the fitting, rehabilitation and adjustment can be delivered to a high standard and with the approval of the claims manager, which must be requested in writing.

What the insurer will pay for

ReturnToWorkSA or a self-insurer will pay for:

• Audiology/Audiometry services where there is an accepted claim for the treatment of a work injury or condition;
• Audiology/Audiometry services and products that are reasonable and necessary and clinically justified;
• Replacement of hearing devices where necessary, subject to prior written approval from the claims manager;
• Binaural Hearing packages for demonstrated compensable hearing loss in both ears.

What the insurer will not pay for

ReturnToWorkSA or a self-insurer will not pay for:

• Non-attendance or cancellation fees for treatment services;
• Services invoiced in advance of the service delivery;
• Audiologist/Audiometrist travel time;
• Pre-payment for services and/or products that are not pre-approved;
• Products or services that have been funded by an existing government scheme (e.g. Hearing Services Australia);
• Two monaural hearing packages within a 3-month period. If there is binaural hearing loss, the binaural fitting fee item must be used.

Consequences for non-compliance with fee schedule and policy

ReturnToWorkSA has systems for monitoring compliance with billing and payments rules. The incorrect use of any item referred to in the ReturnToWorkSA fee schedule and policy may result in the service provider being required to repay payments that have been incorrectly received.

Replacement of hearing devices

ReturnToWorkSA considers the expected life of a hearing aid is at least 5 years. A completed “Request for a replacement hearing aid” form will be required for a claims manager to determine if the replacement is a reasonable and necessary expense. No replacement hearing aid will be paid for without the completion of the “Request for a replacement hearing aid” form and approval by the claims manager.