This is particularly true if, in the past, there is evidence that the individual poses a danger to himself or others, or if he is at risk of suffering a serious setback from his mental health. Case-by-case agreements are most common in patients who have created trust problems and developed a professional relationship with their current ABA provider. It is also important to note that some insurance providers have standard protocols for a case-by-case negotiation. Some have a “Pay At The Highest Rate,” as if you were a network provider. This is based on their rates with no room for negotiation. If the patient has recently switched insurance providers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B 60 days since the insurance change) to allow the patient to continue treatment with the current network provider while switching to a network provider. 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. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. 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 considered as a factor in granting the SCA. 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 provider before the start of treatment.
In an off-grid scenario like this, it may be possible to use a case-by-case agreement to ensure that your client has the coverage he or she needs to receive the care he or she depends on as a doctor or therapist. 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. Amvik Solutions not only understands the requirements your agency needs to get a single case agreement, we also recognize that it can be important to get your assurance proof so that you can increase your patient`s burden, receive payment for your rights and do what you can do best – offer useful and quality ABA therapy services. Contact us today at (805) 277-3392 to learn more about our services and how we can help you in your ABA practice. Case-by-case agreements must also use medical billing codes authorized for the CPT abA. It is important to spell them in the negotiation process with the insurer. This reduces the risk of deferred demand. In the event of a transition to a new network provider, the CPT code for the SCA may be specific to the number of sessions remaining. Insurance providers can only assign a specific code in this case or for patients. Some insurers require that the agreement on a case-by-case basis be in the rendering provider, which must be submitted on the 1500 application form.