Single Case Agreement Aetna


However, remember that if you indicate the reasons for the need for an SCA, it remains honest and justified. To beautify is to cheat. The application of an SCA usually takes two categories: the new client or the current patient. If you are trying to get an ACS for a new patient, you should consider the patient`s (family) needs for your specialty and the usefulness of your closeness to them. If you help a current patient apply for a CAS from a new insurer, you justify the need for the agreement by insisting on continuity of care. As an ABA treatment provider, you may want to consider negotiating a single case agreement (SCA) to provide services to a patient. These agreements exist between insurance companies and off-grid providers (OONOs) for which OON is recognized as an in-network provider (D.D.D. While it is usually the patient who asks his insurer for the SCA, on the basis that there are no other INN providers for ABA therapy in their field, your agency still has to agree on the terms and rates for the services provided. Since insurers are not legally required to provide an CAS, it is essential for you to present them with the benefits of providing you with this opportunity.

Keep in mind, however, that if you provide the reasons for the need for an SCA, it remains honest and justified. To beautify is to cheat. The application for an SCA is usually in two categories: the new client or the current patient. If you are trying to get an ACS for a new patient, you should consider considering the need of the patient (family) for your specialty and the benefit of your closeness to them. If you help a current patient apply for an CAS from a new insurer, you justify the need for the agreement by insisting on continuity of care. Also keep in mind that you must have defined your patient`s financial responsibility to your agency until an CAS is issued. You may decide not to provide services until the CAS has been authorized or you can agree on a financial agreement for meetings that are not covered by the agreement (just because an CAS is in good standing does not mean that it will be backdated). Always ask for an SCA for the OON plans you work for to get permission. Consider the following strategies to help you get a single case agreement: If you receive an SCA for a current patient for further treatment, then the negotiated rate is based on informed agreement and patient agreement when you start therapy.

Rate increases are consistent with your pricing policy in informed consent. You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. Sometimes an insurance company may have a “payment policy with the highest in network rate,” in which case you will not be able to negotiate the rate. You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. If the patient has recently switched insurers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B).B 60 days since the insurance change), so that the patient can continue treatment with the current network manager while switching to a network operator. If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example). If this is necessary to switch to an in-network provider, a case could be invoked for an increase in adequacy with the current supplier. Examples: a patient has an uncertain bond and finds it very difficult to trust others. The therapeutic relationship already established with the current supplier can be seen as a vehicle for granting the SCA.

As an ABA treatment provider, you should consider negotiating a case-by-case (SCA) agreement to provide services to a patient.