Important Information about HCF Physiotherapy Benefits

==== Statement form the APA ====

We have received a number of recent member enquiries about HCF’s letter ‘Important Information about HCF Physiotherapy Benefits’.

The APA has seen a copy of this letter. We understand that HCF is refusing to rebate their health fund members for Pilates or other exercise classes using the Group Consultation item number 560. The confusion is caused by the APA’s National Physiotherapy Services Descriptors, which define a class as a setting in which all participants perform the same exercises and a group as a setting in which exercises are individually tailored to each participant.

In the past, health funds have accepted claiming for Pilates classes and other exercise classes under item code 560 Group Therapy. Group classes, usually involving say three participants performing individually tailored exercises, have in the past been claimed as a 505 Standard Treatment. This is because each of the three participants in such a group setting receive the equivalent of a 1:1 treatment session, with say 15-20 minutes individual 1:1 time in each 1 hour group session.

Since our APA Descriptors specify that in a group setting, exercises are individually-tailored – HCF has obviously revised their policy to say that a 560 item code cannot be used for a Pilates class.

This is a problem as the current HICAPS codes make no allowance for a class, just for a 560 group. We are currently in the final stages of working with Private Health Australia (PHA) to revise the HICAPS Codes, to include a group and class consultation as separate descriptors. We expect to have new HICAPS Codes in early 2014.

In the meantime, there is still the problem of HCF requiring a GP or medical specialist referral before a patient can attend a physiotherapist for Pilates and exercise classes. We also take issue with HCF insisting that a benefit towards the cost of such a class can only be claimed through HCF’s Health Management Program and not under a physiotherapy program.

The APA contacted HCF to discuss some time ago but we have not yet received a reply. We will continue to pursue this issue and will update our members as soon as we receive more information from HCF.

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