How Insurance Works
At Santa Clara Kids Therapy, we will work with you to help you navigate your insurance. We also practice courtesy billing: we will bill your insurance on your behalf.
In California and many other states, occupational therapy is covered by most insurances for children diagnosed with Autism Spectrum Disorder (ASD). This is because the California autism bill, SB 946, mandates occupational therapy coverage for children diagnosed with ASD for most insurances.
Here is California's autism bill, SB 946.
Occupational therapy may also be covered for children with other diagnoses. You can call your insurance, at the number on the back of your insurance card, to check if occupational therapy would be covered for your child.
If the insurance requires an authorization for OT, we will help you with the authorization process.
Here is an explanation of common insurance terms. For more information, please see CMS's helpful chart here.
Please contact us if you need assistance with navigating your insurance.
In California and many other states, occupational therapy is covered by most insurances for children diagnosed with Autism Spectrum Disorder (ASD). This is because the California autism bill, SB 946, mandates occupational therapy coverage for children diagnosed with ASD for most insurances.
Here is California's autism bill, SB 946.
Occupational therapy may also be covered for children with other diagnoses. You can call your insurance, at the number on the back of your insurance card, to check if occupational therapy would be covered for your child.
If the insurance requires an authorization for OT, we will help you with the authorization process.
Here is an explanation of common insurance terms. For more information, please see CMS's helpful chart here.
Please contact us if you need assistance with navigating your insurance.
Term |
Insurance Coverage |
Example |
Deductible |
The deductible is the amount of total annual covered medical expenses (i.e. doctors, ABA, speech, OT) that you are responsible for paying, before insurance kicks in. |
Deductible of $2000: you are responsible for paying a total of $2000 towards any of your covered medical expenses that year. After you've paid a total of $2000 towards any of your covered medical expenses that year (i.e. doctors, ABA, speech therapy, OT), your insurance will kick in. |
Coinsurance |
Coinsurance is the % of medical expenses you are responsible for, after you've paid your deductible, until you reach your out-of-pocket maximum. |
Coinsurance of 30%: you are responsible for 30% of your medical expenses, after you've paid your deductible, until you reach your out of pocket maximum. |
Out-of-Pocket Maximum |
Out of Pocket Maximum is the maximum amount you will pay in total in a year for medical expenses. After you reach your out-of-pocket maximum, your insurance is responsible for all of your medical expenses. |
Out-of-pocket maximum of $5000: once you've paid $5000 in total towards any covered medical expense, your insurance will cover all of your medical expenses in that year. |
Copay |
The copay is a fixed amount you are responsible to pay for each visit, after you've paid your deductible. For most insurances, there will be no copay after you reach your out-of-pocket maximum. |
Copay of $20: You will pay $20 for each visit after you pay your deductible. |
