The Famous Medibank Winter of 2013

By Rebecca Barnett

In today’s episode, we will be taking Mr Peabody’s wayback machine to 2013. Strap yourself in because this is a fairly long ride.

AMT v Medibank Private.

Those of you who have been members of AMT since before the middle of 2013 will recall the dark days of the infamous Medibank provider number freeze. AMT’s membership has increased by 50% since then so that means there’s a heap of you who may not know the colourful story of our David and Goliath battle to protect the integrity of our nationally recognised qualifications.

Medibank Announces Its Plan

In mid 2013, Medibank announced its plan to revise its criteria for remedial massage therapy providers and to temporarily close its books to new provider numbers on 1 September 2013.

Medibank advised the associations of its intention to introduce minimum education requirements for provider status that were outside the standards of the national training package, including proposed qualification duration requirements for the Diploma of Remedial Massage.

It was a significant move for a number of reasons, not the least of which being that it was a reversal of a decade long trend towards adoption of the National Health Training Package for provider eligibility by all the private health insurance companies.

It didn’t make any sense.

What the …? Trying to make sense of Medibank’s decision.

A Glimmer of Opportunity to Change Medibank’s Mind

However, Medibank had not yet finalised its criteria so there was a window of opportunity to negotiate for changes that would actually address Medibank’s concerns about ballooning provider numbers in its system.

Over numerous face-to-face meetings, including a forum organised by AMT with representatives from Medibank, ANTA, ATMS, AAMT, ASQA and the then Community Services and Health Industry Skills Council, AMT tried to inform and educate Medibank about national competency standards, and explain why having a non-aligned education standard was not a good outcome for either the fund or the industry at large.

The measures Medibank was proposing to improve the quality of providers appeared to be pretty arbitrary and meaningless, and would clearly not address the issues the fund was concerned about.

With the September 1 deadline for the provider number freeze looming, Medibank was inundated with thousands of requests for new numbers, as therapists panicked about the blackout. Ironic?

September 1 arrived and AMT was plunged into a long, dark teatime of the soul. For over a year, we were unable to forward a single new provider or provider location to the fund while we negotiated the terms of their agreement. Imagine that! Twelve months in the Medibank wilderness.

But I am getting ahead of myself …

A United Front From Massage Associations?

Through September and October 2013, we waited nervously for the new Medibank provider agreement to arrive. On a Tuesday evening in November, I met with the CEOs of AAMT and ATMS to discuss a coordinated response to the impending Medibank changes. We agreed to move forward as a united front; a promising but ultimately fragile accord.

Medibank’s New Agreement

The new Medibank agreement arrived exactly a week before Christmas 2013.

Merry Christmas massage industry!

All AMT’s worst fears were confirmed. Medibank adopted a qualification duration requirement and other criteria we weren’t sure how to meaningfully interpret.

We started asking questions to clearly and precisely establish what the terms of the agreement meant for AMT and the industry at large:

What does 12 months Diploma duration mean? Does it include holiday and semester breaks? Does the TAFE February to November academic year meet the duration requirement for example? Medibank answer: We just want to be treated the same as HCF.

Does it include time taken to complete the pre-requisite Certificate IV? Medibank answer: The duration requirement relates to the Diploma course only.

Does the course duration requirement preclude accepting qualifications via legitimate RPL? Medibank answer: Every effort should be made to establish the time it took the provider to achieve their Diploma.

What are “other associated therapeutics and techniques”? Medibank answer: Instead of listing every technique in the addendum I went with this wording. I assume you would know them better than I would.

What is the rationale for surface anatomy to be delivered on campus as opposed to, say, gross anatomy? Medibank answer: Advice we received suggested it should be on campus.

Insert your own exasperated profanity here.

The Darkness Descends

Medibank had us over a barrel – no signed contract meant the freeze on provider numbers persisted. And no Medibank provider number effectively meant no HICAPS. AMT members were getting anxious. At stake, though, was the integrity of our competency standards: AMT could, at best, only identify three RTOs whose delivery may have met the Medibank provider requirements and, even then, we weren’t completely certain. As far as we could ascertain, only one dog and his boy were going to be eligible for provider numbers.

Significantly, the two largest private providers of the HLT50307 Diploma of Remedial Massage did not meet the Medibank criteria including, notably, Endeavour College of Natural Therapies which was frequently cited by Medibank as a compliant provider. That was both confusing and worrying.

ANTA signed the new Medibank agreement before Christmas 2013 and eagerly shared the news with their members.

Don’t Worry, We Still Have Our United Front of Massage Associations …

AMT went into the 2013 Christmas break anticipating some vigorous dialogue with ATMS and AAMT in the new year. As a united force, we still had substantial power to negotiate the terms of the agreement with Medibank. With our combined memberships, we had the potential to display some serious industry muscle, potentially a watershed.

Or Not

In the third week of January 2014, AMT was informed second hand that AAMT had signed the Medibank agreement. The AMT/AAMT/ATMS triumvirate was broken. AMT had only just engaged our law firm to represent us in the anticipated negotiations.

On February 13, AMT’s lawyers sent a letter to Medibank requesting some small but significant changes to the agreement. Along with qualification duration requirements, one of the key problems with the agreement was the lack of grandfathering provisions. Once signed, technically AMT would have to cancel all existing providers in our system. Our lawyers advised AMT that this needed to be addressed. Their letter to Medibank stated:

Shortly after this correspondence was sent to Medibank, we were informed that ATMS was also signing the agreement. To his credit, the then CEO of ATMS called me personally to let AMT know that ATMS had decided to sign. He sounded slightly disappointed.

AMT was effectively now on its own at the negotiation table. This is when things turned decidedly David and Goliathy.

So AMT Fights Medibank Alone

Our legal negotiations with Medibank continued. The fund cheerfully pointed out AMT’s lonesome status in correspondence to our lawyers dated May 2:

AMT Staff Bear the Disgruntled Brunt

Eight months had elapsed since AMT had sent a single new provider location to Medibank. Head Office staff were copping a battering from frustrated and disgruntled AMT members. We wrote a standard but sincere telephone script to deal with these angry calls that in essence said “Sorry. We’re still negotiating the terms of the agreement with Medibank. We understand if you have to jump ship to another association that can issue you with a Medibank provider number. We’ll be sad to see you go but we understand that you may need to.”

It was proving hard to explain to disgruntled members what was at stake. We were officially under siege.

AMT Board Stand Firm, With Moral Support

The AMT Board remained resolute. AMT also had the passionate support of hundreds of disaffected recent graduates who were negatively impacted by the lack of transitional arrangements in the Medibank agreement. We also had RTOs across Australia quietly rooting for us. A number of RTOs even offered financial support to establish a legal fighting fund. While this would have been wonderful in theory, it was not possible for AMT to accept the offers of financial assistance, as it would have created a conflict of interest.

AMT went back to our law firm for advice. We were asked, “How much do you want to spend fighting this?” Our lawyers aren’t greedy but they wanted us to be realistic about how prodigiously expensive taking the case to the ACCC could become. They drafted a final advice to the AMT Board in July 2014 which stated:

Counting the Cost of Medibank’s Stance

There was no Erin Brockovich style victory in sight. Or, at least, not one that AMT could afford. We fired the slingshot but failed to bring the monster down. Our 15-month campaign to defend the integrity of industry-developed competency standards was over. RTOs had already spent much of 2014 hastily re-jigging training and delivery schedules to ensure their diplomas were “Medibank compliant”. RTOs were also forced to absorb a massive administrative burden in reporting compliance and providing letters to associations.

Even now, it’s hard to estimate the costs of this fairly meaningless process to the industry as a whole.

The extent to which AMT’s final sorrow-laden capitulation to Medibank’s requirements in August 2014 has shaped the industry over the past four years is hard to overstate. It provided the backdrop to many of the changes in the HLT52015 training package, leaving RTOs to battle with unhelpfully prescriptive assessment requirements, none of which contribute to better educational outcomes.

It takes a bit longer to get a Diploma of Remedial Massage now but not because there’s more time invested in training but rather because assessment is now so ludicrously burdensome, labour-intensive and unrelenting. Students are assessed to within an inch of their lives.

What Does the Massage Industry’s Capitulation to Medibank Mean?

If I was asked to pick a moment when the industry’s relationship with health funds jumped the shark, then this negotiation with Medibank in 2013/14 would  be it. It was an opportunity for the profession to unify around a common cause but we were atomised by the pursuit of the god almighty provider number.

The saddest realisation of all was the extent to which the pressure for numbers wasn’t even ultimately coming from our members or massage therapists in general but, rather, was being brought to bear by the demands of clinic owners who had built their businesses around point of sale claims. The majority of these people were not even massage therapists. Whose agenda are we serving, using precious membership funds and administration resources?

AMT is currently undergoing an audit with Medibank so reliving this history is an unsettling experience. The over-reach of the fund has, again, been amplified by its request for copies of application forms of new members as part of the suite of documents to be audited. AMT politely but firmly declined to provide the forms on the basis that it would be a breach of our privacy obligations to our members since they contain personal information that the fund has no authority to request or access.

Perhaps we were alone in taking that stand too.

About the Author

As accidental CEO of AMT, Rebecca Barnett has been at the coalface of professional advocacy for 12 years. Her proudest achievements include the release of the AMT Code of Practice in 2013 and the establishment of AMT’s classified massage therapy research database. She is devoted to neologism and foodstuffs with the same specific gravity as havarti cheese but right now she could do with a nice glass of merlot. It’s really quite late and she’s still at her desk.

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