Single Case Agreement (SCA)

What is a Single Case Agreement (SCA)?

A Single Case Agreement is a contract between an insurance company and an out-of-network provider for a specific client. An SCA enables clients to see an outside provider using their in-network benefits (i.e., paying the routine in-network co-pays for sessions after meeting any deductible). The insurance company negotiates the fee per session with the provider. In some cases, the client pays a small out-of-pocket amount to the provider as part of the SCA.

 

What are the conditions for a Single Case Agreement (SCA)?

Insurance companies are legally obligated to provide patients with adequate treatment by properly trained professionals. If the in-network services provided are inadequate or there are no in-network providers with a given specialty, the client can advocate the need for an SCA. Many of my clients specifically seeking a therapist experienced in providing ongoing culturally competent care with transgender youth have successfully been approved for SCA. Approvals for SCA can be obtained before the start of treatment.