Pilate
s and Private Health Insurance Reforms – Can I claim my class on my Private Health?
From 1st April 2019 changes were made by Department of Health to the legislation for using private health insurance to cover Natural Therapies, in short most of the natural therapies (including Pilates) have been removed from your private health insurance because they are not medically based, and being taught by non professionals. Which means that when you go to claim your Clinical Pilates classes you will be knocked back, as Pilates will no longer be recognised in your extras cover.
What does this mean?
The Department of Health along with consultation with the APA, recognised the importance of these classes being taking by trained professionals (Physiotherapists and Exercise Physiologists), they have recognised the training and expertise in clinical settings. Physiotherapists and Exercise Physiologists are eligible to deliver exercises drawn from Pilates as part of a treatment program. However we can no longer call these classes Pilates so our our class names will change from Pilates to Clinical Exercise (Equipment) to more accurately reflect our rehabilitation focus. And we must ensure that a specific criteria is met by every person if they wish to claim classes.
At Woopi Physio, our Clinical Exercise (Equipment) classes fall under the Group Consultations item code through your private health insurer.
YOU must check if you have cover for Group Classes with a Physiotherapist (Ciata & Scott) and/or our Exercise Physiologist (Justine) – as different instructors who lead our classes.
The codes are different for claims and the cover is different for every policy. You MUST check with your insurance company as we cannot guarantee what rebate you may receive.
The codes you need to check with your private health fund are:
Physiotherapy Code (Ciata & Scott) 560 AND Exercise Physiology Code (Justine) 502
For example: If you attend a class with Justine our Exercise Physiologist and you do not have Exercise Physiology cover on your policy then you will not be able to claim the cost of that class. Some policy only have cover for physiotherapy lead classes and some policies may not cover it at all.
We cannot always process HICAPS directly so you may have to take an invoice/receipt to your health fund to claim your refund.
What is the Criteria?
Woopi Physio clinical exercise classes meet the criteria to claim the Group Consultation code by including:
- A thorough Initial assessments with a Physiotherapist or Exercise Physiologist
- Sessions led by a Physiotherapist or Exercise Physiologist ONLY
- Accurate clinical records with appropriate outcome measures
- Regular reviews to track progression and set appropriate goals
- Individual programs with a combination of clinically appropriate exercises
- Using the correct language on our programs & invoices that accurately reflects the service provided
- Woopi Physio will deliver exercise within an evidenced-based and therapeutic framework, rather than simply for fitness
- DON’T FORGET – YOU must ensure that you have the appropriate cover with your health fund for Physiotherapy Group classes AND Exercise Physiology Group classes, as our instructors do change and you may not be covered with all of them.
Will Woopi Physio be making any changes?
Woopi Physio classes have always been designed to assist individuals in meeting their specific goals, we run our classes on rehab focus and include not only pilates exercises but also strengthening, stretching and balance work. It’s based on a clinical diagnosis, patient goals, what people are aiming to achieve and it’s tailored for each individual. While we do not need to make many adjustments to the we way we conduct classes, we have made some adjustments which are important for you to be aware of moving forward.
- Our class names will change from Pilates to Clinical Exercise (Equipment) to more accurately reflect our rehabilitation focus.
- Woopi Physio will regularly monitor your exercise program to ensure is still appropriate, challenging, and relevant. If you have not had a recent assessment, we recommend booking in for one to have an updated clinical picture of your needs and can update your program to reflect any relevant issues or new goals.
- If you do want to claim with your private health insurance and have completed one of our assessments, please advise the instructor prior to the class to ensure they monitor you accurately. Please also check with your private ensurer to ensure you are eligible for cover with Physiotherapy and Exercise Physiology Group Classes as we have different instructors taking different classes.
- If you do not want to claim your class with your private health insurance, then that’s fine too. You have the option to attend our classes without using, or having, private health insurance.
Unsure or have any questions, give us a call on 6654 0237.
