Pilates and Private Health Insurance: What’s Changing in 2024?

Back in 2019, the Australian Government made changes to private health insurance that removed rebates for several natural therapies, including Pilates, due to limited clinical evidence at the time. These changes to Pilates claims were part of broader Private Health Insurance reforms introduced in 2019. 

The reforms aimed to make private health cover simpler and more accessible, including the introduction of standardised product tiers (Gold, Silver, Bronze, Basic), improved access to in-hospital mental health services, and discounted premiums for young people aged 18-29. They also introduced clearer clinical definitions, greater powers for the Private Health Insurance Ombudsman, and allowed consumers to choose higher excesses to reduce premiums. These measures were designed to improve transparency, affordability, and value across the private health system.

Fast forward to 2024! 

The Federal Government has completed a new review, which you can read here, assessing the clinical effectiveness of 16 natural therapies that were excluded from private health insurance rebates since the review in 2019. Only therapies with moderate or high-quality evidence of clinical benefit were recommended for re-inclusion, including Yoga, Pilates, Tai chi, Shiatsu, Naturopathy, Western herbal medicine and Alexander Technique. You can read more about these therapies here. 

As a result, Pilates has now been recommended for re-inclusion in private health insurance Extras cover. However, it’s important to note that each private health fund will decide whether or not to include Pilates, and what the claiming criteria will look like. Implementation by insurers may take some time, there is no fixed start date for when these therapies will be covered again.

In this blog, we’ll explain what this means for you, what to expect if you’re doing Pilates at our clinic, and what steps to take next if you want to claim through your health fund.

What does this mean for my classes at Move for Better Health? 

If you have always been able to claim your Physio classes from Move for Better Health, there is no change to that. As these classes are run by Physios, and Physios are qualified allied health professionals, who can diagnose issues and prescribe exercises, you should be able to claim for the classes which are under the Physiotherapy Group and Class consultation item code. If you have not been able to claim for specific classes – like our Movement or Reformer classes under the usual physiotherapy codes, you may now be able to claim for them. However, as each private health insurer is its own private company, they can enforce their own rules if they choose.

At Move, our Physio Exercise Classes fall under the Group Consultations private health insurance item code.

These Group Consultations are:

• Based on a thorough initial assessment with a Physiotherapist
• Have an evidence based and therapeutic framework and treatment plan 
• Run by Physiotherapists

We also:

• Record clinical notes for each class you attend, to track your progress and any issues you’re experiencing
• Perform regular reviews of your exercises to keep them up to date and relevant for you
• Use correct language when providing you with the relevant tax invoices to submit your private health insurance claim.  This language is in line with the changes to private health claiming, and accurately reflects the item code you are claiming

Our Physio Movement Classes and Physio Reformer Classes fall under the Class Consultation private health insurance item code. 

This is because these classes are: 

• Designed for general fitness, maintenance and strengthening with all participants doing the same exercises for the duration of the class
• Led by a Physiotherapist 
• All participants undergo an initial assessment before starting classes 
• Clinical notes are kept for all classes to track your progress and any issues you’re experiencing

These steps should mean that your current exercise services will continue to qualify for private health insurance rebates under Physiotherapy, with the majority of private health insurers, providing you have Physiotherapy Extras Cover. It is always best to check with your individual providers regarding your personal circumstances if you are unsure. 

What else do I need to know? 

Some private health insurers require you to have a Physiotherapy assessment every year if you are currently partaking in Group or Class Consultations with a Physiotherapist. (Although as we mentioned before, each fund has its own rules, so to be certain if this applies to you, we recommend you check with your insurer directly).

If you are attending a class which falls under the Group or Class Consultations code and have not had a review within the last 12 months, then we advise you contact us to book one in.

We have always recommended regular reviews, especially if your condition has changed. Reviews are important in ensuring your exercise program is still appropriate, challenging, and relevant. It also means that we can adapt your exercises to suit any new goals or issues which may have developed since your program was originally written.

What do I do if my private health insurer says I can’t claim for my classes? 

Each fund is its own company with its own rules. If your health fund doesn’t cover Physiotherapy Group or Class Consultations, feel free to speak to us and we may be able to assist you to find one that does.

Remember – you don’t need to have your Extras and Hospital cover with the same Private Health Insurer, you can get your Extras through one insurer and Hospital with another if you find that works better for you.

We do offer alternate payment options for classes, for example 10 session passes, which brings down the cost per class. If you are unable to claim private health, this may be a good alternative to consider.

We’re pleased to see Pilates recognised for its clinical benefits! While some private health insurers may begin to reintroduce rebates for Pilates delivered by qualified providers, this is not guaranteed across all policies or insurers. 

Hopefully this gives you some more insight into these changes. This review was conducted by the National Health and Medical Research Council (NHMRC) and overseen by an expert panel. The decision to reinstate these therapies was based on updated, high-quality evidence. You can learn more from the Department of Health and Aged Care here.