Pilates and Private Health Insurance reforms

Recently there has been a lot of confusion surrounding the changes the Department of Health have made to legislation regarding private health insurance. Many of you have questions surrounding how this may impact your classes at Flex. We have put together some frequently asked questions which we hope will assist with your queries and put your mind at ease. 

How will these changes to legislation affect my ability to claim for Pilates classes?

The purpose of these changes is to remove private health insurance funding for therapies which are not medically based. Several types of natural therapies, including Pilates, will no longer be eligible for private health insurance rebates from 1st April 2019. As you may be aware, there are many different types of Pilates classes that run across Australia, including many which are not run by Physiotherapists. Some classes are run for fitness purposes only and not run by qualified instructors. These types of classes will no longer be claimable with private health insurers.

How will this affect my classes at Flex?

At Flex, our current Pilates, Fab 50’s+, Mums & Bumps & Dance Pilates options fall under the Group Consultations item code through your private health insurer. Flex exercise classes meet the criteria to claim the Group Consultation code by including:

  • Thorough initial assessments with a Physiotherapist 
  • Sessions led by a Physiotherapist 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 

Will Flex be making any changes?

Flex classes have always included a clinical diagnosis and have been designed to assist individuals in meeting their specific goals. 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 Flex FIT to more accurately reflect our rehabilitation focus. 
  • Flex will monitor the frequency of Group Exercise reviews to ensure your exercise program is still appropriate, challenging, and relevant. If you have not had a recent assessment, we recommend booking in for one pre-April to ensure we have an updated clinical picture of your needs and can update your program to reflect any relevant issues or new goals. 

What if I do not want to use my private health or want to have a full Pilates based exercise program for fitness?

If you do not wish to claim Physiotherapy Group Consultation under your private health insurance we still recommend you book a regular review, but it is not a requirement for attendance. ​You have the option to attend Group Consultations without using, or having, private health insurance. If you want to have a program that only has Pilates-informed exercises for fitness, that is ok, but you will not be eligible to claim under the Physiotherapy Group Consultation code with your private health insurer. ​

In short, if you have Physiotherapy extras cover, nothing should change and you should qualify for private health rebates, but each health insurer is its own company and they ultimately decide how to interpret & enforce the rules.

If you still have questions regarding the Private Health reforms and how they may impact you, please chat to one of our friendly staff or email admin@flexclinic.com.au