Single Case Agreements (SCA): Is This An Option For You?

What is a Single Case Agreement?

A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network healthcare provider that allows a patient to receive services as though the provider were in the insurance network. In plain terms, the single case agreement means that the insurer agrees to cover care from a specific therapist or clinic for one client and one episode of treatment, even if that provider is normally out of network.

These agreements are particularly valuable when patients need long-term or highly specialized therapy. For example, families seeking Applied Behavior Analysis (ABA) therapy for a child may have built a relationship with a provider who understands the child’s unique needs. If the provider isn’t in the insurance network, a standard claim could be denied.

A single case agreement with insurance bridges that gap, allowing therapy to continue without disruption. Medicaid plans sometimes provide this flexibility as well, making a single case agreement Medicaid arrangement possible when no suitable in-network options exist.

Why Single Case Agreements Matter?

The question of what a single case agreement is often comes up when patients discover that their preferred therapist isn’t listed in their health plan’s network. Without an insurance single case agreement, they might have to start over with a new therapist, jeopardizing progress and continuity of care. For individuals who need extended therapy or who have specific cultural, linguistic, or clinical requirements, switching providers can be stressful and counterproductive.

A single case agreement health insurance contract protects that relationship. It ensures that the insurer treats the out-of-network provider as in-network for that patient’s treatment window. The result is uninterrupted care and the ability to apply in-network benefits—lower copays, reduced deductibles, and more predictable costs.

This stability is crucial in fields like ABA therapy. Consistency and trust between the provider and client are essential for meeting behavioral goals. Losing that connection mid-treatment can cause regression and prolong the therapy process.

Key Requirements for a Single Case Agreement

Insurance companies review single-case agreements individually and expect solid reasoning before granting approval. Several factors typically strengthen a request:

Specialized Service

Insurers want to see that the requested provider offers something unique. This might be a specific therapeutic technique, advanced credentials, or cultural and language skills that are not easily found among in-network providers.

Patient Location

Proximity matters. If the requested provider is significantly closer to the patient than any comparable in-network option, the case for an SCA becomes stronger.

Cost Considerations

The insurer evaluates whether your care will reduce costs over time. If treatment prevents hospitalization, lowers medication needs, or avoids long-term complications, it supports the financial argument.

No Comparable In-Network

Provider, patients, or families must demonstrate they tried to find an in-network therapist and couldn’t locate someone who meets their needs. Documentation of phone calls or provider searches can help.

Continuity of Care is often the most compelling factor, especially for ABA therapy and mental health services. If changing therapists would risk a significant setback, increase the chance of crisis, or disrupt established progress, insurers are more likely to agree.

How to Obtain a Single Case Agreement?

Securing a single case agreement insurance arrangement requires preparation and persistence. Timing is important. Request the SCA at the same time you seek the initial assessment authorization, so all paperwork is processed together.

Do your research before contacting the insurer. Identify local providers and document why they cannot meet the patient’s needs. Insurance representatives will likely perform their own search, so being ready with specific explanations is critical.

Fee negotiation is another key step. Many insurers pay at the highest in-network rate, but they might also propose a sliding scale. Be flexible and understand the insurer’s reimbursement structures.

Finally, provide strong documentation. Include letters of medical necessity, detailed treatment plans, and records of attempts to find an in-network provider. If a patient is already under your care, a note explaining the importance of continuity can make a strong case.

For ABA providers, an approved SCA is only part of the process. Accurate billing and consistent follow-up are essential for reimbursement. That’s where professional ABA billing services come in. A seasoned ABA billing company understands the complexities of ABA therapy billing services, ABA revenue cycle management, and ABA medical billing, ensuring every claim is submitted correctly and promptly.

Expert billing support also aligns with best practices promoted by the ABA coding coalition, helping providers avoid errors that could delay payment. Whether you run a solo practice or manage a team, partnering with experienced ABA billing companies helps maintain cash flow and allows you to focus on client care rather than administrative tasks.

Importance of Consistent Care

For therapies such as ABA, steady and uninterrupted treatment is essential to meeting clinical goals. When a client switches to a new insurance plan, keeping that continuity or creating a thoughtful transition to an in-network provider becomes critical. In many situations, negotiating a single case agreement is the best way to maintain ongoing care.

The need is even greater when there is a documented risk of self-harm, harm to others, or a serious mental health setback if therapy is interrupted. Single case agreements are especially valuable for patients who have difficulty building trust and have developed a strong relationship with their current ABA provider. Practical Takeaways.

A single case agreement health insurance arrangement protects both the patient and the provider. Patients maintain access to a therapist they trust, while providers can continue delivering consistent care. For therapists, combining an SCA with professional billing support ensures smooth reimbursement and reduces administrative headaches.

If you’re a provider or practice owner wondering what is single case agreement is and how it can fit into your workflow, start by reviewing your client base. Identify cases where continuity of care is critical and where no comparable in-network provider exists. For families seeking services, contact your insurance company early to understand their policies and documentation requirements.

Cube Therapy Billing specializes in ABA billing services, offering end-to-end solutions for providers who need help with ABA therapy billing services and ABA revenue cycle management. Our team handles everything from authorization to claims follow-up so you can focus on treatment, not paperwork. For a free consultation, email info@cubetherapybilling.com.

Frequently Asked Questions

What is the purpose of a single case agreement?

The purpose of a single case agreement is to give a patient access to an out-of-network provider while using in-network benefits. It ensures continuity of care when no suitable in-network provider is available, allowing therapy or treatment to continue without interruption.

What is a single agreement?

A single agreement is another way of referring to a single case agreement. It describes the one-time contract between an insurance company and a specific out-of-network provider for a particular patient and episode of care.

What is an SCA agreement?

An SCA agreement is simply the abbreviated form of a single case agreement. It’s a negotiated contract with health insurance that lets an out-of-network provider deliver services to a specific patient at in-network coverage levels.