Insurance & Billing

Looking for Insurance Coverage?

At Peak Potential Therapy, we work with a variety of insurance providers so that nothing can stand in the way of your child receiving the treatments that they need. It is our goal to make finding insurance a simple and quick process.

We accept the following Insurance for our services:

Health Insurances accepted for speech therapy, occupational therapy, and behavior therapy

Our therapy services and programs are typically covered by insurance; however, as with anything, there are exceptions based on policy, carrier, or even employers, which require special permission and a single-case agreement.

Typical agreements with private insurance include the following:

  • All deductibles are paid out-of-pocket (can range from $250 to $7K)
  • Once the deductible is paid, insurance typically covers 80% of the cost UNTIL the out-of-pocket maximum is met. Once this happens, services are typically covered at 100%.
  • There are differences between a co-pay and a co-insurance. The former is typically a flat fee ($20 per visit) whereas co-insurance is a percentage (20% of the cost of the session). Both refer to the client/patient responsibility. Co-pays and co-insurances no longer occur once the out-of-pocket maximum is met.

Insurance trouble? We are here to help! Just contact us at 330-405-8776 or fill out the Contact Us form.

Is Autism covered by insurance?

Yes, Ohio’s Autism Insurance Bill, HB 463, enacted in 2017, requires meaningful coverage for autism services under state-regulated plans.  All private insurance companies, state and federally mandated are required by law to cover therapeutic services. Prior to that, the insurance companies did not cover services such as ABA Therapy, which is a relatively new treatment for children with autism in that it has become a medical benefit for private insurance policies.

To which plan types does the STATE autism insurance law apply?

  • Individual Plans – YES
  • Fully Insured Large Group Plans – YES
  • Fully Insured Small Group Plans – YES

What services are covered by Ohio’s Autism Insurance Bill, HB 463?

  • Speech therapy
  • Occupational therapy
  • Clinical Therapeutic Intervention, including Applied Behavior Analysis (ABA)
  • Mental/behavioral health outpatient services

Does Ohio’s Autism Insurance Bill, HB 463 have caps on coverage?

Coverage is limited to individuals with autism aged 0-14 years. Benefits are subject to maximum annual or weekly limits.

  • Speech therapy is subject to a maximum annual limit of 20 visits.
  • Occupational therapy is subject to a maximum annual limit of 20 visits.
  • ABA is subject to a maximum weekly limit of 20 hours.
  • Mental/behavioral health outpatient services are subject to a maximum annual limit of 30 visits.

Complete a Contact Form to schedule your free one-hour consultation and intake session today.

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