There’s a common tactic used when breaking bad news – choose a time when people are distracted, so they don’t really notice. That’s essentially what happened late last year. Just when we were all distracted by Christmas approaching and end of year madness, many private health insurers (PHIs) notified their policy holders of planned exclusions to their cover from 2019. The changes were instigated by a Federal government decision preventing PHIs from continuing to offer cover for a range of natural therapies, in a bid to curb rising PHI premiums. Unfortunately, the government also decided to include Pilates in this list.
This was a fairly surprising decision, when you consider there is an enormous amount of strong clinical evidence supporting the benefits of exercise for both preventing and managing a range of health problems. More specifically, numerous studies support the benefits of Pilates exercises for problems including low back pain and pelvic girdle pain. Which is why millions of Physiotherapists worldwide use Clinical Pilates to help their patients rehabilitate from a range of clinical problems. Compare this with natural therapy treatments such as homeopathy, which not only lack any firm evidence supporting their efficacy, but conversely have studies refuting their benefit.
Does this mean the end to Pilates benefits from your private health insurance? Well, no – not necessarily.
The Australian Physiotherapy Association (APA) have been in lengthy negotiations with the PHIs over this matter. A recent agreement ruled that when provided as part of a Physiotherapy rehabilitation program for specific clinical conditions, Pilates-based exercises were acceptable, under certain circumstances. But what does this mean?
At the simplest level, if you have Physiotherapy cover as part of your “extras”, and you have been assessed by a Physiotherapist for a particular problem or condition, the Physiotherapist may prescribe exercises as part of your treatment of that condition. These exercises can include Pilates-based exercises. The exercises may be prescribed as a home program, in a class setting, or both. In order to ensure your exercise program remains relevant and beneficial for you, the Physiotherapist will periodically reassess your progress and update your treatment, including your exercise program. This is exactly how I, and most other Physiotherapists, already operate. So, in this scenario, really nothing will change.
What about if your “condition” is being pregnant, or recovering from having a baby?
Statistics show that approximately 50% of pregnant women suffer from low back or pelvic girdle pain in pregnancy. From my experience, over half of the women I have seen in pregnancy-specific exercise classes experience some kind of dysfunction, for at least some part of their pregnancy. Similarly, the majority of postpartum women find their bodies take many months to recover from pregnancy and childbirth – hence the term “the childbearing year”, which includes a 4th trimester of transition back to a pre-pregnancy state. For some women, recovery may take much longer, if they have been unlucky enough to suffer from any number of postpartum issues, including pelvic floor dysfunction, a significant abdominal separation or postnatal depression.
We know that exercise has many benefits, and is recommended, for the majority of pregnant women, for their own health and that of their unborn baby. Exercise is also recommended for women postpartum to help them return to normal fitness and strength. Tailored pregnancy and postpartum exercise programs, which include Pilates-based exercises, have been shown to have positive impacts for those suffering from various pregnancy-related or postpartum conditions. Therefore, for many women, their Physiotherapy-led exercise program would still fall under the category of treatment for a condition, so should still be covered by their PHI.
What about those women who have a completely uncomplicated and problem-free pregnancy and postpartum recovery?
This is where things become a little more unclear. The APA is currently seeking further clarification from the PHIs about this and other matters. However, it can be argued that pregnant and postpartum women present with specific and unique physical changes over this period. Women’s Health Physiotherapists, who have particular knowledge and skills of the changes occurring over this period, are best placed to guide these women in their exercise needs. Indeed, most PHIs are continuing to provide rebates under item codes for antenatal and postnatal exercise classes.
So, most things aren’t actually changing then?
In many ways, for most people attending Physiotherapy-led exercise classes, things won’t seem to change. However, there will be some notable changes.
To ensure you are meeting the requirements of PHIs for periodic reassessment of your condition, you may be required to have a review more regularly. I already recommend those doing individual programs have a review to update their program approximately every 2-4 months. This will now routinely include completing a short objective functional questionnaire. For those doing group classes (such as Pregnancy and Mums and Bubs classes), I already recommend 1:1 assessment before starting classes, and your PHI will now require this as well. Some PHIs may also require periodic reviews if you continue to attend classes over a longer time period.
The other main change you will notice is the name of your class on invoices and online bookings. The big catch from the new reforms is we cannot label any claimable treatment as Pilates. Although the PHIs accept that Physiotherapists use Clinical Pilates exercises as part of our treatment approach, we can no longer call it Pilates – not in our treatment notes, nor on class invoices. Classes or other exercise sessions cannot be marketed or advertised as Pilates either, if clients want to be able to claim rebates.
In my opinion this is somewhat pedantic, and akin to insisting we all start calling eggplants aubergines. All it really serves to do is confuse you, the consumer. The particularly observant amongst you may have noticed I have already changed the name of the classes at Life Cycle Physiotherapy. Classes are now referred to as Physiotherapy exercise classes, in line with APA recommendations.
While the debate continues between the APA and the PHIs on this matter, it is very unlikely the federal government will reverse its decision. Physiotherapists will continue to provide high quality, evidence-based treatments and exercise rehabilitation, as we already do. And some of that may well include Pilates-based exercises... as long as it is by any other name.
If you are confused by any of these changes and have concerns about your cover, then please come and speak with me personally.
Yours in good health,