The Department of Health has made changes to legislation which applies to private health insurance. The purpose of these changes is to remove private health insurance funding for therapies which are not medically based.
There are certain types of natural therapies, including “Pilates”, which will no longer be eligible for private health insurance rebates from 1st April 2019. This has caused a lot of confusion about who these changes will affect and why.
There are different types of Pilates classes in Australia, including many which are not run by Physiotherapists, run for fitness-purposes only (not for clinical reasons), are not helping to manage any current medical issues or injuries, and are not run by adequately qualified instructors. These types of Pilates classes will no longer be claimable with private health insurers.
As Physiotherapists are qualified allied health professionals, who can diagnose issues and prescribe interventions including treatments or exercises, you should still be able to claim for the classes which are under the Physiotherapy Group and Class consultation item code. However, as each private health insurer is its own private company, they can enforce their own rules if they choose.
At Move, our Equipment and Gym classes fall under the Group Consultations item code.
These Group Consultations are:
Because we do these things, these exercise services should continue to qualify for private health rebates with the majority of private health insurers, (providing you have Physiotherapy extras cover).
The classes that do not fall under a Group or Class Consultations code and are not claimable on private health insurance, include our Pilates Mat and Pilates Reformer classes. This is because the classes not tailored to each participant, and are geared more towards fitness, maintenance, and general strengthening.
Many private health insurers require you to have an 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 a 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 strongly 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.
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.
Yes – these changes to Pilates claiming stem from the Private Health Insurance Reforms in 2017. There were a number of other changes recommended in these reforms, which will come into effect from 1st April 2019, including:
Hopefully this gives you some more insight into these changes. If you’d like to read the full list of the private health insurance reforms, which includes further information on administrative changes, options for privately insured patients in public hospital, and changes to support private hospitals, you can visit the Department of Health website.
Alternatively you can visit the Australian Physiotherapy Association, which provides information on all the above, on their website here.