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Single Case Agreements 101

Single case agreements are contracts between an insurance company and an out-of-network health care
provider for specific patients for billing in particular cases. They allow out-network patients to benefits.
from in-network billing benefits.

There are two ways for billing after the approval of SCA. First, the insurance company provides the
allowed amount, finalized as per the agreement. Second, the patient directly pays the total bill to their
provider, which the insurance company reimburses according to the discounts as per the agreement.

What Conditions Do Patients Have to Meet for a Single Case Agreement?
For a single case agreement, you as a health care provider have to advocate for your patient’s billing to
the insurance company. The purpose of SCAs is to address the important needs of the patient; the billing
cost majorly rather than an in-network provider. Following conditions make your patient’s case eligible
for an SCA:

  •  The patient has a clinical specialty, which is not available for any in-network provider.
  •  The geographical location of the patient does not have any in-network providers.
  • The treatment you provide will keep the patient out of the hospital, cutting down the cost of
    medications.
  • A patient who has recently changed their insurance provider.
  • It can also be advantageous to have the patient also reach out to advocate on their own behalf
    detailing why they feel this is where their journey to sobriety will be best served. i.e. a family
    has previously found success in their program.

What to Consider When Approving Single Cases Agreements
Getting an approval for a single case agreement can be a time-taking and frustrating task. Our job is to
assist you with that. However, when the SCA has been approved, our task is not over yet. Here we need
your assistance to consider the following aspects:

  • Make sure you have all the documentation regarding an SCA, including the details of your
    patient’s condition and treatment.
  • Focus on the services included in the contract. When the negotiation on discounts turns in your
    favor, the insurance company might play tricks regarding the services included in the billing of
    your patients. Be clear about what services your patient requires after their treatment and how
    much can the billing be flexible about it.
  •  Once the insurance company fixes the rates of an SCA, make sure the charges are immediately
    added to the bill.

How Can Healthcare Providers Improve Their Approach on an SCA?

Avoiding Hurdles by the Vendors

Negotiations
We at Panacea negotiate to bring maximum reimbursements. We begin by negotiating at 85-90% of
billing charges by effectively communicating the patient’s condition and treatment requirements.
Negotiations are successful when you remain persistent and clinical documentation supports the level of
care. To remain persistent, you must respond to every counter-offer and appeal for the underpayments.
The insurance company will try to create obstacles by stretching the approval process. They know you
do not have a long time for negotiations. Also with our vast database of client with have additional
details on past averages to add to our arsenal.

Out-of-Network Provider
While it may seem hard to get reimbursements with an SCA, the out-of-network reimbursements can be
higher with effective negotiations, resulting in increased profitability. Healthcare providers can have a
better flexibility to set higher reimbursement rates.
The in-network providers have no opportunity to change the rates as the medical reimbursements rates
are set according to their contract. Single Case Agreements can turn out to be very profitable with the
aid of Panacea.

How Inclusive is the Single Case Agreement
We have already mentioned how you must focus on the services included in the agreement. If your
patient requires multiple treatments and therapies, the contract must cover the reimbursement of
billing of all or maximum number of treatments.

Takeaway
We at Panacea provide premium services to negotiate through and make maximum profits with Single
Case Agreements. We are experts at providing solutions for loopholes and policy inclusions/exclusions in
the SCA. Give us a call at 866-731-6777 to find out how we can help you today.

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