If you or someone you know has ever received medical or behavioral health treatment, you might have heard the term “single case agreement” (SCA) thrown around. But what exactly is a single case agreement, and how does it work?
A single case agreement is a contract between an individual and their healthcare provider that outlines the specific terms of a treatment plan for a particular case. Typically, these agreements are used when an insurance company does not have a contract with a particular provider, or when the provider is out-of-network.
The purpose of a single case agreement is to ensure that the individual receives the necessary treatment that may not be available through their insurance. It also allows the provider to get paid for their services, rather than having to write off the cost of treatment as a loss.
Here’s how it works: Let’s say you’ve been seeing a therapist for a few months, but your insurance company does not have a contract with that particular provider. As a result, your insurance company may refuse to pay for your treatment, leaving you with a hefty bill to pay out-of-pocket.
In this scenario, you and your therapist could enter into a single case agreement. This agreement would outline the specific terms of your treatment plan, including the duration of treatment, the type of treatment, and the cost. Your therapist would then submit the agreement to your insurance company for approval.
If your insurance company approves the agreement, they would agree to pay for your treatment as outlined in the agreement. If they do not approve the agreement, you would be responsible for the cost of treatment.
It’s worth noting that single case agreements are not always guaranteed. Insurance companies may deny an agreement if they believe that the proposed treatment is not medically necessary or if they have an alternative provider who is in-network.
If you think that you might need a single case agreement, it’s important to talk to your healthcare provider and your insurance company. Your provider can help you understand the process and work with you to create a treatment plan that meets your needs, while your insurance company can provide guidance on their specific policies and procedures.
In conclusion, a single case agreement is a contract between an individual and their healthcare provider that outlines the specific terms of a treatment plan for a particular case. It’s designed to ensure that the individual receives necessary treatment that may not be available through their insurance, while also allowing the provider to receive payment for their services. If you think that you might need a single case agreement, speak to your provider and insurance company to determine your options.