Hills Blog

Why can’t I claim for Pilates?

Posted December 20, 2018.

Pilates is no longer covered by Private Health insurance

You may have heard via social media, news or on the grapevine that there are about to be some changes to the way that Private Health Insurance companies fund natural therapies, including Pilates.

The review was undertaken by the NHMRC (National Health and Medical Research Council) which is the body that selects and funds research into areas that will be beneficial for public health, but that requires government funding rather than Private or Industry funding (as distinct from Big Pharma etc). The review was part of a series of reforms ordered by the Turnbull Government in October 2017 to reduce the cost of Private Health insurance, making it more affordable for more of the community.

The reforms included;

• Allowing Insurers to discount premiums for 18-29yo by up to 10% (meaning younger, healthier people are not subsidising care for older people with more health concerns)
• An agreement with Medical Technology Association of Australia to reduce cost of medical implants
• Allowing people to select a higher excess to lower premiums
• Changing coverage for the listed natural therapies to ensure taxpayer funds (since the government subsidises Private Health Insurance) are not directed to therapies that do not demonstrate evidence of clinical efficacy (ie there’s no evidence that they are more effective than placebo).

For more information about the changes, please download this document here

All of this reduces the cost to the consumer either by directly reducing the cost of premiums, or by reducing the cost of claims to the insurer, which are then passed on to the consumer as higher premiums.

But Pilates fixed my Back Pain, how can they say it doesn’t work?

Recent reviews of ALL of the exercise programs for Chronic and Acute low back pain (and other injuries but lets start there) have suggested that it doesn’t really matter what type of exercise you do, just that you do it regularly. This has been challenging for Physiotherapists and other health practitioners because it suggests that our sophisticated and expensive exercise programs using complex equipment may be no more helpful to our patients that simply walking regularly, or doing a cycling program.

So, ultimately, it does work. It’s just not magically better than any other exercise program that is administered by a qualified movement expert. And here’s the thing, this doesn’t mean that your back pain is going to be just as well managed doing Pilates with a physiotherapist as going to do F45 with a personal trainer, or even Pilates with a personal trainer / pilates instructor – the key difference is in the appropriate selection and graduation of the exercise program by a professional who understands your injury, your life situation, and what best fits your needs for progressively loading your system until there are no more barriers for you getting back to doing the things you love. I mean, that’s why you come to a physio, right?

The reason that Physiotherapists have jumped on to the system of movement, breathing, and exercise that is informed by the Pilates Method is that it offers a beautifully rich and varied environment for challenging a patient’s body. Traditional exercise therapies can be a bit one dimensional, only training the body in limited directions and situations. This, I think, is why Pilates style exercises DO show superior improvements (for back pain) in the short term (see here) – because they expose people to greater variety, richer context, and reduce fear of movement faster. Ultimately, these differences are washed out in the long run, so long as people are motivated to continue moving and exercising.

So why has the Government removed funding for Pilates then?

Even in high quality research run by experienced Physiotherapists (who have university degrees of 4-6 years and years of experience managing pain and injury with exercise prescription) the results show that Pilates may be superior in the short term, but not in the long term. However, only a fraction of the Pilates classes on the market are run by such expert practitioners. Many Pilates instructors will wax lyrical about how their course required hundreds of hours of teaching and instruction, however this still does not make them a physiotherapist. A physiotherapy course (even undergraduate) is closer to 3600 hours conservatively, and then add the years of experience and professional development required to stay registered, and it becomes obvious why you can’t compare Apples to Oranges, so to speak.

This means that the Private Health funds have (rightly) cut funding to all Pilates classes, because they have no way of regulating whether you are getting high-quality, evidence based exercise and rehabilitation therapy, or simply another exercise class.

In the long run this means that both the Government and the Insurance companies are paying out less money for services that are have little scientific support in the management of Pain, Injury, or health-conditions. By paying out less money, this puts downward pressure on the continually rising cost of maintaining your Insurance policy.

The Good News, and the Bad

In a recent message from the Australian Physiotherapy Association, we have been informed that we (Physiotherapists) will still be able to offer our patients Pilates Informed rehabilitation and exercise that IS STILL COVERED by Private Health Insurance, because (as the Government agreed) “Physio is still Physio” – meaning that whether your Physio decides that the best treatment for you are exercises  from the Pilates repertoire, exercise in a pool, in a gym, or a walking program, this is still within the evidence-based scope of practice of your physio. You can still go to a Pilates-style exercise class run by a qualified physiotherapist, and use your Private Health to rebate this, legally.

However, to insure that the public are not confused by the difference between evidence-based care and lower value interventions that have no scientific backing, we are no longer able to use the name Pilates when we refer to therapeutic exercise classes. 

This may become confusing when you ring up to book in to see your physio for a Pilates class and find that it is no longer called Pilates. It will take a while for the industry to adjust to this change – how are we to market Group Therapy that consists of Pilates-Informed exercise, without using the word Pilates? We’re not sure. Watch this space for updates and further information.

What it DOESN’T mean

It does not mean that Physios can’t teach Pilates, or are not allowed to teach Pilates.

We could still run the same sessions, and call it the same thing, but you wouldn’t be able to claim it on your Private Health Insurance. Since we feel our patients deserve to use their rebates for such a helpful and enjoyable exercise option, we need to educate the public about these changes and about the best way that we can continue to stay up to date with the evidence, the legislation, and government funding intricacies.

The changes all take effect as of April 1st, 2019. Over the next three months, we’ll ensure that we provide adequate information and updates on social media, and at our practice locations to ensure that you experience the minimum confusion possible. Please call 13009HILLS with any questions or contact us at admin@hillsphysiotherapy.com.au or via the contact page here.

 

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