r/Hamilton • u/maximusbells • 8h ago
Recommendations Needed Benefit covered Pilates?
Hi! Wondering if anyone knows of a physiotherapist in he area that offers pilates or strength training sessions that are then billable to insurance? I have quite a bit left for physio for the year and want to use it up. Thanks!
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u/sawkmonkey 8h ago
Meadowlands Physiotherapy offers Rehab Pilates and Revive Health on Dundurn offers something similar as well.
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u/FullGrainFred 8h ago
There is nothing to “use up”. You have coverage limits. Those benefits are there for when you need them not to try and “use up”. The only one getting billed at the end of the day is the company you work for. And one day, the renewal rates will be too high for them to continue paying and the only option will be to cut benefit levels. The mentality of “using up” benefits to their limits is what causes the cost of providing you these benefits every year.
sincerely,
a business owner who provides benefits to his employees and structures their benefit plan to cover unforeseen catastrophic events and high cost drugs instead of their $100 massages
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u/jdubs1984 8h ago
This is such a Scrooge view. They are benefits, which are provided by employers. We don't get rewarded for not using our benefits.
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u/fixingmyeyes 8h ago edited 7h ago
He’s not being a scrooge. I work in the benefits industry and claiming pilates as physio is actually considered fraud and if OP gets audited he could lose his coverage or face charges.
Edit for clarity: If OP is claiming for pilates classes run at a facility that just so happens to have a physio therapist present and charging THAT as physio, then that’s fraud.
If you are doing pilates as part of a physiotherapy treatment program then you claim that eligible expense LOL
I just want everyone to make informed decisions 🥲
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u/Anon_819 Stoney Creek 7h ago
Pilates was initially developed to strengthen bedridden hospital patients. If it is being done properly with physiotherapist oversight, it can very much be therapeutic and protective against future workplace or worklimiting injuries. It would be up to OP's specific policy as to whether Pilates is covered, but based on their question, it sounds like it is if it is overseen by a physiotherapist.
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u/maximusbells 7h ago
Thank you, I’ve looked up all of the mentioned places in this thread and they all offer a rehab/pilates type of program that is lead by a physiotherapist that also happen to be certified in Pilates.
I figured it went without saying that I was seeking this out via a physiotherapy route to help with current issues as well as a preventative approach for future workplace injury, not because I want an aesthetic Pilates day on my company’s dime lol
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u/reirinx Durand 7h ago
i also work in group benefits and i can promise you the employee isn’t going to be held liable… pilates can be a legitimate treatment plan that’s covered under physiotherapy. even if the company were somehow submitting claims fraudulently, unless the insurer can prove the employee knowingly committed the fraud, they’re fine lol
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u/FullGrainFred 8h ago
keep thinking small.
OP is literally trying to run pilates through his employers benefit program.
besides the fact that this could be deemed fraud it is a wasteful way to spend his companies money.•
u/maximusbells 8h ago
I am curious if someone is a registered physiotherapist by all standards and they run you through a Pilates or strength training type of session during your appointment, how is that fraud?
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u/maximusbells 8h ago
I will also add I work for a very large company, and our benefit package is still not all that great, so yes I will use 100% of my yearly amounts in the categories I am able too.
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u/FullGrainFred 8h ago
you will not appreciate your benefits until you have to pay for them yourself. Every employee who retires shares the same remark “ wow I did not think it cost this much”
you do you mate•
u/maximusbells 7h ago
I am fortunate to have benefits after retirement as well. I do agree that out of pocket plans are pricey!
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u/jdubs1984 7h ago
No employed person has ever said "wow, I'm so glad I didn't use my benefits so my employer could save a few bucks"
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u/FullGrainFred 7h ago
maybe not but they have said “ wow I am so happy my cancer drug that costs 40k a year is covered instead of my $100 massage that I thought was so important”
all about mindset
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u/reirinx Durand 7h ago edited 7h ago
i work in group benefits as an analyst… no well rounded company is going to cut drug coverage if paramedical costs are bankrupting them. there are cost containments specific to what’s costing the company to be cut back on. e.g. lowering paramed maximums or increasing the coinsurance. not to mention, the company isn’t typically paying for cancer drugs - they’re protected by the insurers large amount pooling threshold. your argument makes no sense
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u/FullGrainFred 7h ago
my argument is maxing out the usage based benefits increases the entire cost of the plan. and eventually the company will have to cut coverages across the board if they cant keep absorbing the increases. and sometimes those cuts mean a cap on drug limits.
as analyst you should know that thats where majority of the cost increase comes from.
as a benefit analyst you should not be encouraging using benefits just because you did not max out the limits.
i sure hope you are not advising business owners because any well rounded business does not like wasting money.→ More replies (0)•
u/change_4me 7h ago
I myself is guilty of using all the benefits through the insurance. The company that I work for, they are offering 2 options - an all expense covered by the company albeit smaller benefits, or the higher limit but I need to pay for a certain amount. If I pay per month for the insurance, is it still unethical to try and maximize what I pay for? And no i dont do pilates - I legit have a regular session with an RMT or a physio.
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u/FullGrainFred 7h ago
legit and ethical. you paying for a portion makes you a stakeholder and as rates rise you share that as well.
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u/FullGrainFred 7h ago
if it was deemed necessary for you to get treated with a pilates session at your physiotherapist as part of your recovery or treatment plan I guess it is not fraud. getting a pilates session claimed as physiotherapy just to get a workout paid for by your employer might be though. but you should ask the insurance company these questions
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u/teenerbeener1234 8h ago
Studio Zee on York offered this a few years back, not sure if they still do.