Single Case Agreement Vs Letter Of Agreement
One thing to keep in mind is that insurance companies are legally required to properly treat patients by properly trained professionals. Therefore, if the insurance plan does not cover out-of-network services and there are no networked providers with the indicated specialization, you can, as a trained provider, negotiate your usual full meeting fees for new patients. This is because the patient does not simply choose to see you, but is forced to do so with insufficient network providers. In this case, the patient usually asks the insurance for an ACS with you before starting treatment. This denial disturbed me so much that I turned to one of my former economics professors who now teaches business strategy in healthcare at Harvard Business School. Certainly, she could help me think about it a little. From an economic point of view, their response has been that economists believe that the “selective contract” is necessary for a reduction in negotiated rates and therefore probably served as a basis for rejection. Part of the networked process involves negotiating highly discounted rates for insurance companies and their members of a selected group of suppliers in exchange for volume. She also noted that if the insurance company agreed to pay for the treatment of this woman in an establishment that is not currently in the network, it could possibly upset another provider on the network.
Needless to say, none of the reasons seem to have any basis, even approximate, for refusing care in this case. Illinois has an “any willing provider” status, but unfortunately it does not apply to this case. As an ABA therapy provider, you may want to consider negotiating a single case agreement (SCA) to offer services to a patient. These agreements are concluded between insurance companies and out-of-network service providers (OON) with which the OON Agency is recognized as an in-network network provider (DSD). While it is usually the patient who requests SCA from their insurer, based on the absence of other DNS providers for ABA therapy in their area, your agency should always agree on the terms and rates of the services provided. Since insurers are not legally required to provide an ACS, it is important that you present them with the benefits of this possibility. Remember, however, that you remain honest and justified about the justification for the need for A.A. To embellish is to deceive. The ACS application generally falls into two categories: the new client or the current patient. If you are trying to get an ACS for a new patient, you need to consider the needs of the patient (family) in your specialty and the advantage of being close to them. If you are helping a current patient apply for an ACS from a new insurer, you justify the need for the agreement by emphasizing continuity of care.
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