It is unfortunate that not all insurers offer the same level of coverage and may not have their own limited networks for patients. Getting familiar with the agreement process on a case-by-case basis can help you keep patients and ensure they receive maximum care. What is the extent of the single box agreement We have already mentioned how you should focus on the services included in the agreement. If your patient needs multiple treatments and therapies, the contract must cover reimbursement for all treatments or the maximum number of treatments. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network. In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. A case-by-case agreement is intended to meet the patient`s basic treatment or therapy needs and the cost benefits to the insurance company, without having to switch network providers. As a general rule, the following criteria must be met to guide the negotiation process. These include: If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the out-of-network network provider before the start of treatment.
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.
