A single case agreement (SCA) allows an out-of-network therapist to be temporarily reimbursed at in-network rates for a specific client. When the right conditions exist, an SCA can make specialized care accessible to clients who cannot find a comparable in-network provider.
What Is a Single Case Agreement?
A single case agreement is a one-time, client-specific contract between an insurer and an out-of-network provider. For the duration of the agreement, the provider is reimbursed at in-network rates — or a negotiated rate — rather than standard OON reimbursement. The client typically pays their in-network cost-sharing (lower copay/coinsurance) rather than OON rates.
When to Request an SCA
SCAs are most likely to be approved when the client can demonstrate that no comparable in-network provider is available:
- Specialized trauma treatment — EMDR, Somatic Experiencing, or trauma-focused CBT with no in-network trained providers in the area
- Eating disorders — Few in-network providers with eating disorder specialization; payers are often more flexible here
- LGBTQ+ affirming care — Client documents difficulty finding affirming in-network providers
- Language/cultural access — No in-network provider fluent in the client's language
- Continuity of care — Client was seeing you when they changed insurers and now you are OON
- Established therapeutic relationship — Switching providers would cause clinical harm (e.g., trauma processing mid-treatment)
How to Request a Single Case Agreement
- Client calls member services — The client (not the therapist) initiates the request by calling the member services number on their insurance card. They explain they cannot find an in-network provider with the required specialty.
- Document the search — The client should document their in-network search: dates called, provider names, why each was unavailable (not accepting new clients, wrong specialty, location too far, etc.).
- Therapist submits credentials — You provide a current CV/resume, copy of your license, NPI, and a brief clinical justification for why this client requires your specific specialty.
- Negotiate the rate — The insurer may offer their standard in-network rate for your CPT codes, or may propose a different rate. You can counter-negotiate.
- Get the agreement in writing — Confirm the approved CPT codes, approved number of sessions, effective dates, and reimbursement rate before seeing the client under SCA terms.
What to Negotiate
When the insurer offers an SCA, push for:
- Your full fee (or as close as possible) rather than the insurer's typical in-network rate
- At least 20–30 sessions covered (not just 6–8)
- A renewal clause if treatment extends beyond the initial approved period
- Direct payment to provider (assignment of benefits) so you receive payment directly rather than the client having to forward reimbursement checks
SCA Is Not Guaranteed
Payers are not legally required to grant SCAs in most cases. Approval is at the insurer's discretion. HMOs are less likely to approve SCAs than PPOs. Medicaid managed care plans rarely grant SCAs for mental health.
If the SCA Is Denied: Continuity of Care Letter
If the SCA is denied but the client has an established therapeutic relationship with you, request a continuity of care letter instead. Many states require insurers to honor continuity of care for a defined transition period (typically 60–90 days) at in-network rates when a provider leaves the network mid-treatment. Check your state's continuity of care law.
SCAs vs. Superbills
If an SCA is not available, OON billing with superbills is the alternative. The client pays your full fee and submits a superbill for OON reimbursement. Superbilled makes it easy to generate compliant superbills for every session when an SCA is not in place.