Pilates in a sweat as health insurance rebates tighten against natural therapies

Looming restrictions on health insurance coverage for natural therapies have practitioners ­worried about a sudden drop-off in customers.

Health insurers have been ordered to remove therapies including aromatherapy, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, tai chi and yoga.

Looming restrictions on health insurance coverage for natural therapies have practitioners ­worried about a sudden drop-off in customers once they discover they are no longer covered for those services.

The government expects the restrictions to “dampen demand” for natural therapies, with naturopaths and exercise physiologists likely to be the most ­affected by insured customers no longer receiving a subsidy.

Industry concerns have prompted the Department of Health to clarify the status of popular activities such as Pilates.

Three years ago, The Weekend Australian revealed a review by the National Health and Medical Research Council had found little or no proof that 17 natural therapies were clinically effective. That put indirect government support for the sector into question.

The then health minister, Sussan Ley, declined to intervene, and a ministerial advisory committee was unable to reach a consensus on the issue. Last year, however, Health Minister Greg Hunt decided to impose restrictions as part of a broader package of insurance reforms.

Of the therapies reviewed by the NHMRC, only massage will continue to qualify for insurance benefits after April 1, due to there being some evidence of benefit (and also its popularity).

Insurers have been ordered to remove therapies including aromatherapy, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, tai chi and yoga. Each quarter, they pay out about $50 million on natural therapies overall, and it has been suggested the move will put downward pressure on premiums and the taxpayer-funded rebate.

The Weekend Australian has learned that in meetings to discuss insurance reforms, the restrictions have prompted the most questions from stakeholders. Insurers have been urged to do everything possible to notify members of the change, which comes ahead of hospital policies being recategorised into gold, ­silver, bronze and basic.

The Private Health Insurance Ombudsman is alert to the possibility of an increase in complaints from members who find their bills no longer covered.

Medibank has started contacting members about the change, reminding them that remedial massage, exercise physiology, Chinese medicine and acupuncture may still be covered.

The department recently responded to insurers and other groups inquiring whether the ban would apply to providers who include elements of natural therapies in treatments.

“The most often identified scenario is a physiotherapist providing Pilates services,” the department informed stakeholders.

“The department considers 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.

“If a physiotherapist (or other health professional) conducts a Pilates session — either advertised or promoted as such, or a session where the only service provided is Pilates exercises — benefits cannot lawfully be paid. The same principle applies to any other excluded natural ­therapy.”

Some insurers wanted to keep covering natural therapies, believing it helped attract younger, healthier members whose premiums would offset the cost of older members. They will instead be able to offer premium discounts to young people, including existing members, from April 1. Natural therapies can still be offered as an inducement for people to take out cover as long as insurers aren’t spending too much on it.