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 a new patient requests an CAS, the insurance can ask if the patient needs your specialty or geographic convenience. Similarly, CAS could be authorized if the treatment you can offer could reasonably be argued to keep the patient away from the hospital or to reduce the cost of medication. The client has tried and cannot find a practitioner or supplier in his network that meets his needs in a way that allows him to feel comfortable. For treatment with ABA, this must be done before the start of treatment. There have been a few exceptions in which I have contracted with insurance companies for single case agreements (SCAs) that have been beneficial to all parties involved. Here`s what you need to know about SCAs to represent on behalf of your patients. What are the conditions that patients must meet in order to reach an agreement on a case-by-case basis? To obtain a case-by-case agreement, you, as a health care provider, must commit to billing your patient with the insurance company. The goal of the SCAs is to meet the important needs of the patient; billing costs a network provider more than a network provider.
The following conditions call into question your patient`s case for an CAS: For an ongoing patient who has taken out new insurance: Be prepared to negotiate your costs. This may be on a slippery scale or the insurer could already have its own fee schedules. This can be part of a “Pay at highest in network rate” protocol. Once an agreement has been reached, the new conditions set out in the CSA will apply. Since an CAS is rarely dated, it is important for the patient to understand his or her financial responsibility in all the intermediate windows between coverage or where the CAS is not granted. Proactive work on the process reduces the delay in care, which benefits both the therapist and the patient. Takeaway At Panacea, we offer premium services to negotiate with unique case agreements and make maximum profits. We are experts in providing solutions for political loopholes and exclusions in the SCA. Call us at 866-731-6777 to find out how to help you today. You have a clinical specialty that is not available from any of the network providers (the specialty can include cultural skills) Whenever the economy moves, as we are currently seeing with COVID-19, patients are more likely to lose or change insurance. As insurance coverage is an important factor in any patient-therapist relationship, a change in this coverage can pose a risk to your practice.
More importantly, at a time when patients probably need it most, they remain without their usual support. 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. In such a situation, negotiations are under way between the network provider and the practitioner in need of care. The overall goal is to ensure that the insurance provider pays similar fees per session in order to keep the out-of-pocket cost to the customer as close as possible to the original. In the case of a patient who needs to move from your care to a new network provider or a patient who prefers to remain in your care, you may need to help the patient make the request to the insurer.
