Private Health Fund Claims

It seems (that for now anyway) the decision has been made with regard to the payment/reimbursement of Pilates through Private Health Insurance.  The bottom line is that as from 1 April, 2019, Pilates will no longer be a claimable commodity.  There has been talk for some months now that clients would still be able to claim Pilates classes taught by physiotherapists.  This has finally been laid to rest with the release of the Department of Health circular of 19 December, 2018 on Private Health.


The Private Health Insurance circular states:

…that an insurer may lawfully pay benefits if a physiotherapist, providing services to a patient within the accepted scope of clinical practice, uses exercises or techniques drawn from Pilates as part of that patient’s treatment as long as the exercises or techniques are within the accepted scope of clinical practice. However, if a physiotherapist (or any other health professional) conducts a Pilates session – either advertised or promoted as such, or a session where the only service provided is Pilates exercises – then benefits cannot lawfully be paid.


Therefore, if you are being given/taught a selection of Pilates exercises within a physiotherapy session to produce a specific result for a particular condition then you will be able to claim that session through your health fund if you are covered for physiotherapy.  Any group or private classes regardless of who teaches them, will no longer be claimable. And that’s that – done and dusted.


Personally, I find this a sad state of affairs.  A Government who applies tax penalties for those who are not  members of a private health fund, has now decided to take away a host of preventative alternative therapies including Pilates.  Yes it is this same Government who is spending millions of dollars on advertising campaigns encouraging Australians to stay healthy: eat healthily, exercise.  Hypocrisy? Only you can decide how you feel about that.


Let me leave you with this thought….A lot of people are now questioning the benefits of private health care.  And quite a deal of people – from all accounts – are leaving health funds or in the case of the younger generation just not joining.  What do you think the Government is going to do in 10, 20 or 30 years when an aging population who were denied any rebate for preventative healthcare through their private health fund, all require hospitalisation for chronic health issues?

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