Whenever the economy shifts, as we’re currently seeing happen with COVID-19, patients are more likely to lose or change insurance. Since insurance coverage is a major factor in any patient-therapist relationship, a change to that coverage can be a risk to your practice. Even more importantly, it leaves patients without their usual support during a time when they likely need it most.
But a change of insurance doesn’t have to mean goodbye.
Many therapists are using Single Case Agreements (SCAs) to retain patients experiencing a change of insurance. An SCA is an agreement between a therapist and an insurance company you are Out of Network with (OON) that allows you to effectively be treated as In Network for a particular patient’s case. Patients benefit from receiving continuity of care with the same therapist they’re familiar with, and therapists benefit by maintaining relationships with patients and often attaining the same, or similar, rates.
So how does an SCA work, in practice?
1. Patient requests SCA
Typically, the patient requests an SCA from their new insurance provider. This means that when changes are coming to insurance coverage, it’s helpful to have a conversation about whether there would be benefit to trying to continue the relationship under an SCA. The patient usually contacts a behavioral health representative of their insurance company.
2.Therapist negotiates with insurance company
Next, the therapist will need to accurately describe the benefits of continuing with the patient.
For a long term patient, the new insurance company may respond positively to the justification that you are providing continuity of care. If the patient can’t afford the OON benefits to see you, and if there could be setbacks in progress if they had to start over with a new (in network) therapist, make sure the insurance company is aware of this.
In the case a new patient is requesting an SCA, the insurance may want to know if the patient has a need for your specialty or geographic convenience. Likewise, if the treatment you can provide could reasonably be argued to keep the patient out of the hospital or reduce the cost of medications, the SCA might be allowed.
Regardless of the personal situation, an SCA needs to be accepted by both the insurance provider and the therapist. We recommend therapists negotiate rates so they are at or close to going rates.
3. Therapist and Insurance provider sign the SCA
Once an agreement is reached, then the new terms outlined in the SCA will be valid. Because an SCA is rarely backdated, it’s important that the patient understands their financial responsibilities in any interim windows between coverage, or in the event the SCA is not granted. By being proactive about the process, the lag in care can be shortened, which benefits both therapist and patient.
When we go through hard times, we need to rely on mental health professionals more than ever. Understanding the process and the elements of a strong case for a Single Care Agreement is one way we can continue serving and strengthening our local communities.
