These guidelines should be read in conjunction with our General provider guidelines.
Who can provide optometric services?
You can provide services if you are registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the optometry profession (other than as a student).
What we can pay for
We can pay the reasonable costs of optometric services, without prior approval, immediately after a transport accident when they are required as a result of a transport accident injury. We can pay for:
- Optometric consultations.
- Computerised perimetry.
- Spectacle glasses and contact lenses.
- One pair of basic non-prescription standard sunglasses, when required as a direct result of the transport accident.
- Replacement of prescription glasses that are damaged in a transport accident.
- Provision of basic equipment. Our approval is required for specialised equipment. Please read our Equipment guidelines and use the Equipment Prescription Form to submit written requests.
We will review our client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask you and our client for information during these reviews and may temporarily stop funding treatment if we don’t receive it.
Reviews help us understand our client’s injuries, treatment needs and goals and how to best support them to get their life back on track. After a review we’ll let you and our client know the decision regarding further treatment.
Other things to note
For accidents that occurred prior to 14 February 2018 a medical excess may apply. Visit the medical excess page to see if it applies to your patient. If the medical excess applies you will need to invoice the client directly.
As part of your patient’s treatment, you can complete a Certificate of Capacity to assess and certify your patient’s capacity for work.
Gap in treatment
If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment. Ask our client for a copy of their approval if you haven’t seen them in 6 months.
How much we can pay
We can pay for services in line with our Optometry fees.
What we cannot pay for
We cannot pay for treatment or services provided by an optician. The cost of these services is included in the cost of the glasses.