PRIVATE HEALTH INSURANCE REFORMS - April 1st 2019

Physiotherapy, Pilates and Private Health Insurance rebates..

As many of you know, the federal government has recently reformed parts of the Private Health Insurance Act. These changes were aimed at eliminating rebates paid for the unregulated ‘natural therapies’ eg homeopathy and naturopathy, and were never intended to impact the already highly regulated science-based health professions like Physiotherapy.

The National Health and Medical Research Council conducted this review and has looked extensively at the research over the last 3 years. The following is a list of specific items the government will no longer allow Private Health Insurers to pay for (from April 1st 2019). It has now been determined there is no scientifically validated efficacy for these treatments:

"Alexander technique, aromatherapy, Bowen therapy, Feldenkrais, Western herbalism, homeopathy, iridology, kinesiology, naturopathy, reflexology, Rolfing, shiatsu, yoga, Tai Chi and Pilates".

Unfortunately, this means any intervention associated with the term ‘Pilates’ has now been ‘caught up’ in these reviews, even ‘Clinical Pilates’! One reason is that ‘Clinical Pilates’ is not a protected title - meaning you could use the term even if you are not a Physio, or even if you do not have appropriate pilates training. It should also be noted that the research assessed was restricted to the term ‘Pilates’ (no distinction is made for that taught by a Physiotherapist).  As you know, Physiotherapists have always used exercise rehab as a primary part of our intervention to: 

• improve your mobility
• increase physical function
• strengthen muscles
• reduce pain
• increase bone density
• improve cardiac / respiratory capacity
• reduce injury recurrence
• improve sporting performance
• Improve mental health outcomes
• recover from (or even avoid) surgery and much more. 

And of course we will continue to do this, as the evidence is abundantly clear - in many cases, Physio-lead exercise is definitely the best medicine!

Some of the exercises Physio’s use are inspired by the original method of Pilates. But we have always adapted them to the individual with our medical understanding of a patient’s diagnosis, our extensive biomechanics knowledge and our up-to-date research backed treatment planning. Every individual at Mint has an initial assessment with a Physiotherapist to determine their diagnosis and suitability for exercise rehab. This of course is very different to attending a pilates class where all participants are doing the same exercises, and are being taught by a pilates instructor - this may be an ideal set-up for your general health and wellbeing, but it is not what the government wants Private Health Insurers to be paying for.

What doesn’t change?

The outstanding clinical Physio service you receive at Mint Wellbeing!
You will still receive rebates for your exercise rehab sessions with a Mint Physiotherapist as long as the following criteria are met:
Initial Assessment (to determine diagnosis, treatment management plan and goals)
Regular review and goal-setting sessions (these have always been available at Mint, on an ‘as needed’ basis, but will now be mandatory and even more structured and valuable to your rehab journey. The re-assessments we have already completed are always a positive experience, as we are able to re-focus on the specific goals and aims of your Physio interventions, assess any new problems  you are having or ideally be able to progress you and challenge you more!

It is important to note - there have not been and will not be in the foreseeable future any government mandated changes to rebates for Physiotherapy. Physiotherapists are primary-care practitioners; this means you can see us without a referral from a GP, because in Australia, a Physiotherapist’s training is sufficient to determine your diagnosis and whether or not you need a scan or any further evaluation. A Physiotherapist registered in Australia is a highly trained health professional who is able to determine if your condition will respond to Physiotherapy (which includes exercise rehab), or whether you need to see a GP for a different type of medical management. Physiotherapists work in hospitals in almost every ward - ICU, cardiac, obstetrics, gynaecology, orthopaedic, neurological (eg stroke or spinal), urological, respiratory, mental health and more! You can also access Physiotherapists directly in the community in private practice for sports injuries, spinal pain, arthritis, musculoskeletal pain, pelvic floor, headaches, vertigo, pregnancy and postnatal issues and much more. The Australian Government recognises the valuable contribution Physiotherapists make to our health care system, and as such, none of this will change.

What does change?

Physiotherapists are no longer allowed to use the term ‘Pilates’ (even ‘Clinical Pilates’) as the primary descriptor of our service. At Mint, we will of course protect your rebate and will comply with these new rules. So you may notice some marketing changes on our website and small administrative changes eg appointment names will not include the word ‘Pilates’.

An extra note.. 

We are aware that some health funds have started contacting patients in other practices and asking them to describe specific details about their physio interventions. Whilst we, as a business, are not concerned about this (as we know we are compliant with all requirements), please know that should this occur to you, this is not sanctioned by Mint, and we have definitely not provided any details of your visits to the health fund. Your health fund will have access to the dates only (from your claim). We do not provide any private medical notes without patient consent. 

Should you get a call from your health fund, it seems they are trying to ascertain two details:

• Have you had an individual assessment by a Physio?
• Does the session include not ‘only’ pilates - ie does it use a physio’s knowledge to individualise exercises (both pilates-inspired exercises and ‘regular’ physio exercises). Eg any exercise which uses weights, bands, resistance springs, is on the bosu, with a ball, on the roller, balance exercises etc are of course all ‘physio exercises’!

Physiotherapists (as with all registered medical professionals like doctors and specialists) are regulated by the Allied Health Practitioner Registration Agency, as well as the Australian Physiotherapy Association who provide further Codes of Conduct and Guidelines for all private health fund claiming. Private Health Funds are insurance businesses, not regulatory bodies of medical professionals. Any contact by a private health fund is merely to assess your eligibility for an insurance claim - it is not an investigation into a practitioner’s capability or integrity, and obviously should not be misconstrued as such.

Remember the aim of this review was to stop rebates on low value care, that is not consistent with current evidence. We understand, that lining numerous clients up in a class environment and having everyone do the same pilates class is not well evidenced (though likely still has much benefit!); But this is not how we have ever conducted ‘pilates’ at Mint. 

Exercise remains one of the highest value interventions and is heavily backed by medical research, across many sectors of our healthcare system. As such, Physiotherapy and Physiotherapist-lead exercise interventions at Mint will continue to be rebated by your private health fund. 

Should you have any queries or questions regarding your Physio Rehab at Mint Wellbeing, please do not hesitate to contact Amber directly (amber@mintwellbeing.com). We look forward to continuing to provide our high level of evidence-based Physiotherapy interventions at Mint Wellbeing. 

For more information on the government review:

http://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-removing-coverage-for-some-natural-therapies