Mental health problems are increasing. In just a decade, anxiety disorders doubled among young Americans, affecting 14.66% in 2018. After the pandemic, they have only gotten worse around the world. A study published in The Lancet estimated that 76.2 million additional cases were diagnosed, an increase of 25.6%.
Last year, the number of people diagnosed with depression in the United States also skyrocketed to 29%, almost 10 percentage points higher than in 2015, according to a Gallup poll. This pattern is repeated in other mental disorders, which is why the demand for psychologists is increasing.
However, health insurance, originally designed to cover the cost of treatment of physical illnesses, does not always have a suitable team of professionals or cannot offer the appropriate type of therapy. In these cases, it is possible to resort to a tool that is as useful as it is unknown: the Single Case Agreement.
What Is a Single Case Agreement?
“Also known as SCAs, Single Case Agreements are contracts between an insurance company and an out-of-network provider. These types of contracts typically cover a specific client receiving a service for a designated length of time at an agreed-upon rate”, as explained by Missing Piece, a pioneering company in this sector that laid the foundations for insurers to accept ABA therapy. It currently advises professionals on the legal and administrative issues related to this solution so that they can focus on providing quality treatment.
Thanks to the Single Case Agreement, the person can be treated by a psychologist not part of the insurer’s network, a particularly important possibility when more specialized treatments are needed or one suffers from a rare disorder.
Typically, the insurer negotiates the rates directly with the therapist and assumes the agreed amount or reimburses the patients for what they have paid, according to the discount provided in the policy.
However, not all insurance companies or psychologists can sign this agreement. Even if the insurer is willing to cover the treatment, the professional is not obliged to accept it if its terms are not viable. Today, only 55% of psychiatrists accept insurance, according to research published in JAMA Psychiatry.
What Are the Advantages for Patients?
The Single Case Agreement is a valuable tool for most insured people for several reasons:
Expand treatment options
The psychological care service is overflowing. A survey by the American Psychological Association (APA) revealed that 41% of psychologists have had to increase the number of sessions to address the increasing severity of symptoms, and more than half said they could not accept new patients. The Single Case Agreement opens up people’s options to find the right professional in the shortest time possible, even if they are outside their insurer’s provider network.
Access Appropriate Treatment
Those who suffer from disorders such as anxiety or depression do not usually have great difficulties finding treatment in their insurer’s network of psychologists. However, those who suffer from other problems, such as autism or borderline personality disorder, may have difficulty finding the type of specialized therapy they need. The Single Case Agreement is a solution that allows them to access quality therapy that can truly improve their quality of life.
Reduce Costs
A study conducted at Harvard Medical School and Massachusetts General Hospital found that the cost of therapy in the insurers’ provider network is lower. During the decade examined, and after analyzing more than 90 million therapies through insurance, they found that the average cost of these sessions was $21 within the network and about $60 outside it. Therefore, the Single Case Agreement can help you access quality psychological care at a lower cost.
What Criteria Must Be Met To Request a Single Case Agreement?
This tool is designed to meet the therapeutic needs of patients, but some requirements must be met:
- Very specialized service. Insurers must provide quality treatment within their provider network; if they cannot, they have to cover outside treatment. It usually occurs when the patient needs therapy belonging to a specialty not available in the network, generally due to its special characteristics.
- Limitations of the own network. The Single Case Agreement is viable when restrictions in the insurer’s network prevent patients from accessing the treatment they need, either because they are unavailable or due to age, gender, religious preference, or even linguistic or cultural reasons. In those cases, the person can seek an outside psychological service.
- Patient location. The majority of psychologists have returned to in-person sessions. It is estimated that only 21% of the population still offers online therapy, compared to a peak of 64% in 2020 during the pandemic. Therefore, the Single Case Agreement could also be activated when no professionals in the patient’s geographical area can guarantee the therapy people need.
- Cost reduction. A Single Case Agreement can also be signed when the service provided represents a benefit for the patient and reduces the cost of care, either because it eliminates the need for hospitalization or reduces the consumption of psychotropic drugs. This solution is usually approved for the most serious psychological cases that have required recent hospitalizations or have a history of suicidal ideation or self-harm.
- Continuity of treatment. If the person has recently changed insurers, the new company will likely cover a limited number of sessions for a certain period so that they can find a suitable professional in their network of providers. However, if it is shown that this transition could be iatrogenic, he can request to continue with the same therapist.
In general, Single Case Agreements focus on guaranteeing the quality of the level of care that the patient needs when there is no suitable professional in the insurer’s network or it is impossible to provide the ideal treatment.
However, insurers usually require that the therapy be based on clinical evidence and have scientific support, so alternative treatments are often excluded from this solution.
The Single Case Agreement is typically extended for as long as the treatment is necessary. If the patient ends the therapy and then decides to resume it, he will have to negotiate a new Single Case Agreement with his insurer.
References:
Benson, N. M. & Song, Z. (2020) Prices and Cost-Sharing In-Network vs. Out-of-Network for Behavioral Health, 2007-2017. Health Aff (Millwood); 39(7): 1210–1218.
Novak, P. et. Al. (2018) Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act. Adm Policy Ment Health; 45(6): 924–932.
Bishop, T. F. et. Al. (2014) Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care. JAMA Psychiatry; 71(2): 176-181.
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