How to Request a Single Case Agreement: Step-by-Step Guide for Providers

If you work in ABA therapy or another healthcare field, you may have families who want to keep seeing you even though their insurance lists you as out of network. A single case agreement is a one-time contract with an ABA insurance company that lets you treat a specific patient at in-network rates.

Requesting a single case agreement is straightforward when you stay organized and follow each step carefully. This guide explains the process from start to finish so patients can continue care without unexpected costs, and helps clarify how the SCA insurance term applies throughout the process.

Understanding Single Case Agreements

A single case agreement is a contract between a healthcare provider and an insurance company that gives in-network benefits for one patient and one treatment plan.

ABA Insurance companies approve these agreements when their existing network cannot meet the patient’s needs or when there are clear access barriers.

For providers, a single case agreement allows you to continue working with your patient and be paid at the in-network rate instead of a lower out-of-network amount.

Read More About What is a Single Case Agreement

For families, a single case agreement means their child or loved one can receive consistent care without the stress of excessive out-of-pocket costs. This combination of patient access and fair reimbursement is why a single case agreement is often the best option when network gaps exist.

Step 1: Verify Benefits and Coverage

Begin by calling the patient’s insurance company. Ask if the plan allows out-of-network care through a single case agreement and request details about the patient’s benefits.

Find out the deductible, copay, coinsurance, and any limits on services. Ask for the department that handles single-case agreements and the preferred submission method. This call ensures you know the requirements and helps you avoid surprises later.

A detailed conversation at this stage sets the tone for the entire single case agreement process. It signals to the insurer that you understand their system and are prepared to meet their documentation standards. Knowing exactly what the ABA insurance company requires will save time and help you create a strong request for the single case agreement.

Step 2: Gather Complete Documentation

The insurer needs proof that the requested services are medically necessary and that you are qualified to provide them. Prepare:

• Accurate diagnosis codes. For ABA therapy, F84.0 for autism spectrum disorder is common.

• A detailed treatment plan with goals, number of sessions, and expected outcomes.

• A letter of medical necessity from the treating physician or BCBA explaining why the patient needs your care.

• Your credentials, certifications, and any specialized training that support your request.

Clear, complete documentation is key to a successful single case agreement. Each piece of evidence shows why this single case agreement is not only reasonable but essential for the patient’s care.

Step 3: Show Network Gaps

Insurance companies approve a single case agreement only when in-network providers cannot meet the patient’s needs.

Research local in-network providers and document why they are not an option. Note long waitlists, lack of needed expertise, or providers not accepting new patients. Record the date and name of each contact. If language needs, cultural factors, or accessibility issues exist, explain why these make in-network care difficult.

If the patient already has a strong therapeutic relationship with you, include clinical notes showing why switching providers would disrupt progress.

Providing clear evidence of these gaps strengthens the single case agreement request and makes it easier for the insurer to justify approval.

Step 4: Submit the Request

Once all documents are ready, send the request through the insurer’s preferred method—secure portal, fax, or email.

Your cover letter should include:

• Patient demographics and policy number

• Diagnosis and clinical justification

• Your credentials and practice information

• All supporting evidence of network inadequacy

Ask for confirmation that the single case agreement request was received and for a reference number for tracking. A professional, organized submission increases the chance that your single case agreement will be reviewed promptly.

Step 5: Follow Up Regularly

Reviews for a single case agreement often take 10 to 30 business days. Call weekly to check on the status. Write down the name of each representative, the date, and any updates.

Stay polite but persistent. If delays occur, ask to speak with a supervisor or request an expedited review based on medical need.

Frequent, respectful follow-up helps keep your single case agreement from getting stuck in the insurer’s system and shows your commitment to timely patient care.

Helpful Strategies

Encourage the patient or family to call the insurer as well. Member inquiries can speed up the processing of a single case agreement. Keep organized digital copies of every document and note each phone call.

If the request is denied, file an appeal with additional clinical information or updated network evidence.

By creating a repeatable checklist for each single case agreement request, your practice can respond quickly whenever a family needs out-of-network coverage.

Over time, these well-managed single case agreements become a vital part of maintaining stable cash flow and continuous care. For practices offering ABA billing services, a solid system also streamlines payment tracking and keeps revenue predictable.

Why Single Case Agreements Matter

A single case agreement allows patients to continue needed care without high out-of-network costs and ensures providers are paid fairly. It also helps insurance companies identify gaps in their networks so members can access timely treatment.

For ABA therapy providers, mastering the single case agreement process means families do not have to interrupt treatment, and children receive consistent support. For other healthcare professionals, a single case agreement provides a similar bridge between medical necessity and insurer limitations. 

Providers that pair this process with professional ABA credentialing services can further simplify payer communications and shorten approval times.

Quick FAQ

How do I request a single case agreement? 

Call the insurer to verify benefits, gather full documentation, show network gaps, submit the request, and follow up until approval. Using experienced ABA billing services can help ensure every step is properly documented.

How long does it take to get a single case agreement? 

Most requests are processed in 10 to 30 business days, depending on the case and the insurer’s review time.

What is a single case agreement with health insurance? 

It is a contract that allows an out-of-network provider to treat a specific patient at in-network rates when the insurer’s network cannot meet the patient’s needs.

By verifying benefits, preparing thorough documentation, proving network gaps, submitting a clear request, and following up, you can navigate the single case agreement process efficiently and help patients receive the care they need.

Repeating this process whenever necessary ensures that both patients and providers benefit—and when combined with ABA therapy billing services and expert ABA credentialing services, it strengthens financial stability and keeps care uninterrupted.