A Single Case Agreement (SCA) is a contract between insurance and an Out-of-Network provider for a specific client so that the client can see that provider using their IN-Network benefits. The fee per session that will be paid by the insurance company is negotiated by the Provider and the Payer as part of the SCA.

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If the client has recently changed ABA providers, then the insurance can agree to a limited number of sessions and period to allow the client to continue the ABA treatment with the current Out-of-Network provider, while transitioning to an IN-Network provider. The therapeutic relationship that has already been established with the current ABA provider may qualify as a factor for granting the SCA.

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An SCA has to basically address the unique needs of the clients and the cost benefits to the ABA billing company of the patient seeing you, rather than an IN-Network provider. If the patient has had no luck finding an adequately skilled IN-Network provider, then the patient makes the case for an SCA with the Out-of-Network provider BEFORE commencing treatment.

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