What Is A Single Case Agreement

What conditions must patients meet for a case-by-case agreement? For a case-by-case agreement, as a health care provider, you should recommend billing your patient to the insurance company. The purpose of SAs is to meet the important needs of the patient; billing costs are more those of a networked provider. The following conditions make your patient`s case suitable for an ACS: Once an agreement has been reached, the new conditions in the SCA are valid. Since ACS is rarely reversed, it is important that the patient understands their financial responsibility in any intermediate windows between coverage or in the event that ACS is not granted. By taking a proactive approach, the time to care can be shortened, benefiting both the therapist and the patient. One thing to keep in mind is that insurance companies are required by law to treat patients appropriately through properly trained professionals. So if the insurance plan does not cover off-grid services AND there are no networked providers with the specified specialization, as a trained provider, you can negotiate your usual full fees as a defined session for new patients. Indeed, the patient does not simply choose to see you, but is forced to do so with an insufficient number of networked providers. In this case, the patient usually asks the insurance company for an SCA with you before starting treatment. The insurer`s mindset here is to offer what they think is the fairest rate.

However, this can still be lower than your standard rate. Especially if you are a specialized supplier. In a scenario like this, you still have the option to refuse the terms and rates they offer, although this means that your patient/client will be without care. Not only does Amvik Solutions understand the requirements your agency needs to get a one-time case agreement, but we also know how important it can be to get your insurance eligibility so you can increase your patient burden, receive payments for your claims, and do what you do best – provide meaningful, high-quality ABA therapy services. Contact us today at (805) 277-3392 to learn more about our services and how we can help your ABA practice. Many therapists use single case agreements (SRAs) to retain patients who are undergoing a change in insurance. An ACS is an agreement between a therapist and an insurance company with which you are not connected (OON) that allows you to be effectively treated in a network for the case of a particular patient. Patients benefit from continuity of care with the same therapist they know, and therapists benefit from maintaining relationships with patients and often achieving the same or similar rates. A case-by-case agreement is designed to meet the patient`s essential treatment or therapy needs and the cost benefits to the insurance company without having to switch providers in the network. To lead the negotiation process, the following criteria must generally be met. .

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