If the patient has recently changed insurance providers, the insurance company may arrange a limited number of meetings (approximately 10) and a period (.B e.g. 60 days since the change of insurance) to allow the patient to continue treatment with the current provider outside the network, while switching to a network provider. If there is evidence that the person might pose a danger to themselves or others, or if it affected the patient psychologically/mentally (e.g.B returns during treatment) if this is necessary to switch to a network provider, a case could be made for increased continuation of care with the current provider. Examples: a patient has an uncertain bond and it is very difficult to trust others. The already existing therapeutic relationship with the current provider can be considered as a factor in the allocation of sca. Some insurers require that the case-by-case agreement be that of the rendering provider, which must be submitted on claim form 1500. Many therapists use single case agreements (SCAs) to keep patients who are witnessing a change in insurance. An ACS is an agreement between a therapist and an insurance company with which you are not connected (OON) that allows you to be effectively treated in a network for the case of a particular patient. Patients benefit from continuity of care with the same therapist they are familiar with and therapists benefit from maintaining relationships with patients and often getting the same or similar rates. If you receive an ACS for a current patient for continued treatment, the negotiated rate is based on the patient`s informed consent and consent at the start of treatment with you. Rate increases will be consistent with your pricing policy in informed consent. You can`t charge the patient a lower mobile rate out of pocket and then charge the insurance company your normal full rate if the SCA is back to cover past meetings. 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 address their request to the insurance provider.
If you are a practitioner seeking a case-by-case agreement for a current client who requires continued care, the negotiated rate may be more flexible depending on the client`s preference….