ABA Single Case Agreement
Are you OON ? Lets Do SCA
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.
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.
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.