Private Practice Therapist Working with Insurance Companies: Have no fear, Single Case Agreements are here!

Okay, imagine this: you may have a client that you have worked with in the past that would like to rekindle the therapeutic relationship. But what can be done if you don’t have a contract with their insurance company?

The answer comes down to three words: Single Case Agreement.

What about a potential client that has reached out to you because you are trained in a specific treatment modality that they need, but you don’t have a contract with their insurance company?

Again, that answer is: Single Case Agreement

What is a Single Case Agreement?

Why is this option such a secret? It wasn’t anything covered in my degree, or even in the years of practice working for others. Had I personally known about this sooner, it would have saved me a host of headaches and many frustrated tears.

In essence, a Single Case Agreement is a contract that you as a provider can arrange with an insurance company to see one particular person under their plan—even though you are technically out-of-network. Pretty cool, right? It’s an agreement for the insurance provider to make an exception in your situation. More importantly, it comes at no extra cost to your client, even though you are out-of-network.

But don’t get your hopes up, this isn’t an option for everyone. Large health insurance companies that have many healthcare providers under their umbrella generally won’t be bothered with a SCA. They simply do not have to, their subscriber can go to anyone else in network (to them, you are not special).

Smaller insurance companies, on the other hand, want to take care of their subscribers and give them a reason to stick with them; so they are willing to work with you. What that means for you is that instead of getting discouraged that someone’s obscure insurance provider hasn’t paneled you yet, you can actually be hopeful about the situation — because chances are you can work something out.

When will I need a Single Case Agreement?

I have found Single Case Agreements to be particularly helpful with state funded insurance plans. As a solo private practice, I will never qualify to be credentialed with state insurance or medicaid. In Massachusetts there is a middle ground, something called the Health Connector. Subscribers of the Health Connector make too much of an income to qualify for medicaid, but do not received commercial health insurance through their employer. The Health Connector partners with other health insurance providers and offers a plan that is just as good as a commercial plan, but at a reasonable cost. I truly wish this was an option in other states!

As stated above, this can also be used if you are in the contracting limbo with a health insurance company. You have submitted your documents, and you are waiting for approval. In the meantime, if you have a specific client you are hoping to work with soon, you can submit the Single Case Agreement application.

How to apply for a Single Case Agreement

As with all matters health insurance, each company will have their own application process and hoops to jump through. I’ve now set up a handful of these, and each experience has been different. I have been approved for SCAs that required no explanation of why I was the best fit for their subscriber, while others have wanted a written reason justifying your service. I have even, in one instance, been interviewed by a physician working for a health insurance company to prove the necessity of the SCA. As you can imagine, that was really stressful!

If you already have a therapeutic relationship with a client and they want to continue this in your new practice, this is something you want to jump on to make this transition as easy as possible.

Remember that if a client reaches out to you, they are taking a big and vulnerable step — one that you want to honor as much as you can. Ask them if it is ok for you to contact their insurance provider and begin the SCA process.

TL;DR

If you would like to work with a client that uses a health insurance company that you are not credentialed with, you may be able to apply for a Single Case Agreement, or a individual patient contract with their insurance.

The best way to go about this is to contact the health insurance directly, and ask if it is an option that they provide.