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What you need to know about Pilates and Private Health Insurance

April 1, 2019


As of 1 April 2019 the Department of Health’s private health insurance (PHI) reforms for “natural therapies” are making changes to Pilates.  Fortunately, Physiotherapists are still able to use exercise therapy as a modality of treatment, this includes the use of pilates exercise programs, gym-based exercise and hydrotherapy.  The key is that the use of the exercise is part of a management plan, is goal specific and your program is designed to manage a current condition.


What has changed?


• We can no longer call our groups “pilates”. They will now be called “physiotherapy group exercise”
• To be eligible to claim a rebate from your private health fund, we must be managing a specific condition (for example low back pain, postural neck and shoulder issues, hip pain, arthritic conditions, etc). 
• Your health fund will require ongoing reviews every 6 to 12 months in order for you to continue to claim your exercise program under private health rebates.
• If you have not had a review with a physiotherapist in sometime, your health fund will require you have a reassessment by one of our physiotherapists to re-establish your current condition and review your program and goals. This reassessment must be conducted as soon as possible from 1st April. If you have not had a reassessment your health fund may not pay rebates until you do.  Please discuss this further with your physiotherapist at your next session.


In Stride Health Clinic has always maintained clinic notes, goals and progressions for our clients in our 1:1, 2:1, 4:1 and 6:1 groups.  This will not change, however these reforms will standardise these processes across the industry.  Everything else about our classes will remain the same from your view point, although there will be some additional paperwork required from our therapists.


What do you need to do from here?


If you are not claiming through a private health fund there is no change for you.


If you are attending a 1:1 or 2:1 session then you will also continue as usual.


However, if you attend a 4:1 or 6:1 session and wish to continue to claim through your private insurance, you will need to have a 30minute reassessment with one of our physiotherapists.  This can be either in the clinic or in the studio. 


We will be opening up additional times with our therapists to allow more space for clients to book in a review.  These review appointments will be 30min in length and cost a standard physiotherapy appointment of $85 (code 500 for claiming back through your health fund).


You can book this through your physiotherapist at the studio, or you can book online at www.instridehealthclinic.com.au/bookings selecting a physiotherapy follow up appointment option. 


At this review we will update your goals and your management program for your health funds requirements. 


If you do not have a current health condition for which your exercise program is helping to manage, then you may no longer be eligible to claim these programs through your private health insurance.


Please remember that we have not enforced these changes, they have come from the government bodies that control private health insurance. 

 

If you have any concerns or complaints, do not hesitate to write to either your private health insurer, your local member of Federal Parliament or the Minister of Health (PO Box 6022, Canberra, ACT 2600) 
 

 

 

 

 

 

 

 

 

 

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