Is pilates covered by health insurance? Good question! The answer is it depends.”
Today, “Pilates” is a generic term and the industry is difficult to regulate. Not all classes and teachers have the same level of experience or type of training. Someone who takes a crash course online at the weekend to teach a group class or boot camp with a ton of abs will not have the same qualifications as someone who has completed years of intensive, specialized training. related to e.g. neurological disorders, spinal disorders, prenatal/postnatal exercise, pelvic floor dysfunction, rehabilitation exercise, athletic training, etc.
Is Pilates Covered By Health Insurance?
Insurance companies are all about regulation, uniformity, standardization, and quality control… so Pilates classes are usually not covered by ‘health insurance, even if your master is highly experienced and qualified, and even if his practice helps him get back on his feet. from an injury or managing your chronic pain.
There are some circumstances where Pilates classes are covered by insurance. Within the industry spectrum, there is a variation of Pilates known as “Clinical Pilates” that is specifically geared towards rehabilitation exercises because it overlaps with physical therapy. A certified clinical Pilates teacher can work under the supervision of a licensed physical therapist, and then their classes with you can be covered by health insurance. This can be a great option for those on a budget, as regular private Pilates sessions can be quite expensive.
While we enjoy working with other health professionals such as physiotherapists, massage therapists, osteopaths, and others to create customer service programs, neither Mykaela nor Nadea works directly under the supervision of a physical therapist, so our services cannot be billed to any company. . although in our studio we see many clients with chronic conditions and unique body situations. However, we try to make our classes and sessions as accessible to people as possible by offering our community classes through a donation, as well as regular memberships and packages for people who want to do regular sessions with us. We believe that wellness should be accessible to everyone, regardless of the circumstances!
PRIVATE HEALTH REFORMS
You may have heard of the recent changes in what private health insurers cover. Check out the information below to find out how it affects you.
What are the changes?
Some natural therapies are no longer recognized as evidence of improved health outcomes and will therefore no longer be covered as of April 1, 2019. Check with your fund to see what is no longer covered.
How does this affect me?
Physical therapy remains covered as it is recognized as high-quality evidence-based care. It was initially announced that Pilates would not be covered regardless of who teaches it, including physical therapists. However, the government has concluded that physical therapy is physical therapy and that therapeutic exercise is beneficial. The therapeutic use of Pilates-based exercises is just another treatment tool.
Are remedial exercises reimbursed?
This class was previously called ‘Clinical Pilates. But this name had to be changed to reflect recent changes. If you are currently in a corrective practice class, you are entitled to a refund when:
- Attend an initial consultation
- You are treating a current health condition or injury
- The class does not only consist of Pilates exercises
- Attend regular evaluation visits (most funds require at least once a year) to assess your progress
- Your condition/injury shows signs of improvement from taking classes
- You are covered to claim under code ‘560’ (group exercise)
- I am not treating a current health condition or injury.
- Was my condition resolved in the recovery training class?
- My condition stalls during the recovery exercise class.
You are most welcome to join our Equipment Pilates class. We all know the many benefits that exercise and strength training have on the body. However, you can no longer claim your lessons through your private health insurance. If you make a wrongful claim, you may have to refund the money.
What about the mat classes?
The current changes will not affect Mat in Balanced classes as they do not meet the requirements of private health insurers and you will not be entitled to these classes.
Clinical Rehabilitation And Private Health Benefits
Although pure Pilates is excluded, the Department of Health believes that “an insurer may legally pay benefits if a physical therapist, who provides services to a patient within accepted clinical practice, uses exercises or techniques derived from Pilates as part of the treatment of that patient, provided the exercises or techniques are within the accepted scope of clinical practice.
We offer this form of evidence-based therapeutic group exercises at The Alignment Studio. Based on the principles of Pilates, our Clinical and Rehabilitation Pilates classes can be claimed under private health physiotherapy coverage. These active rehabilitation sessions:
- They are designed, structured, and led by a physiotherapist.
- They are only performed after a comprehensive individual physiotherapy evaluation with each client
- They are highly individualized, meaning each client has a personalized program tailored to their unique biomechanics, pathology, and movement goals.
- Engage clients with injuries, pain, or dysfunction in a dynamic and personalized rehabilitation program
- Includes use of Pilates techniques and equipment (e.g. reformers, magic circles, foam rollers, spinal correctors)
- Require regular checkups to monitor progress and therapeutic outcomes
- They are the surest way to benefit from a clinically appropriate range of motion exercises
Can you claim Pilates with private health insurance?
Not anymore. In April 2019, the Australian government introduced new reforms to private health insurance. As part of these new reforms, several services were completely removed from all policies, including Pilates, Naturopathy, and Homeopathy. However, this does not affect the ability to make claims with allied health professionals, such as physiotherapists, osteopaths, and exercise physiologists, who may use Pilates equipment and exercises as part of their treatment and treatment of clients.