How to Request a Single Case Agreement

What are SCAs?

Single Case Agreements (SCAs) are sometimes called:

  • Single Case Exceptions

  • One-Time Agreements

  • Gap Exception Requests

  • Network Exceptions Requests

SCAs are used when you require specialty services based on a medical need (e.g., a therapist who has specialized training in reproductive mental health, or a therapist who provides comprehensive DBT) but are unable to find an in-network provider that is covered by your insurance because:

  • no one in-network has the specialty training

  • all of the in-network people who do have specialty training are not taking patients or have long waiting lists

SCAs are an agreement between YOU and YOUR INSURANCE COMPANY (NOT an agreement between your provider and your insurance company) whereby your insurance company treats your provider (me) like an in-network provider when it comes time to reimburse you for services, even though I am out-of-network.

For example, let’s say Jane Doe’s insurance company benefits are:

  • in network services fully covered minus copay

  • out of network services 50% covered with a maximum allowed amount of $150 minus copay

  • copay $20

For a $400 service, without an SCA, Jane would get reimbursed $55 by her insurance company ($150 x 50% - $20). With an SCA, she would be reimbursed $380.

Note that even with an SCA you will need to pay out-of-pocket for sessions, but that your reimbursement rate from your insurance company will be higher.

I unfortunately at this time do not work directly with insurance companies on SCAs.

How to Request an SCA:

  1. Call your insurance provider and say: “I am calling to request a Single Case Agreement for mental health services. I would like to request the SCA because I require specialty services, namely a [REPRODUCTIVE MENTAL HEALTH SPECIALIST / DBT SPECIALIST / ETC]. I have not been able to find someone in-network who is currently accepting patients with this expertise.”

  2. Then say: “I cannot afford to see an out-of-network provider without a SCA because my out of network benefits have a high deductible and high coinsurance.”

  3. Then say: “I have found a provider who has the training and expertise in [SPECIALTY AREA] that is medically necessary for my diagnosis/problem. I have asked her, and she is willing to support my application for a SCA. What information do you need from me and from her?”