Single Case Rate Agreement
This is especially true when there is evidence in the past that the person poses a danger to themselves or others, or if they were at risk of suffering a significant setback with their mental health. Case-by-case agreements are the most common with patients who have identified trust issues and developed a professional relationship with their current ABA provider. The insurer`s way of thinking here is to offer what it considers to be the fairest rate. However, this may still be lower than your standard rate. Especially if you are a specialized supplier. In a scenario like this, you always have the option to refuse the terms and rates they offer, although this means that your patient/client will be without care. Be prepared to negotiate your fees. This can be done on a sliding scale or the insurance provider may already have its own fee schedules. This could be part of a “Payment with the highest network rate” protocol. In case a new patient watches an ACS, the insurance may ask if the patient needs your specialty or geographic comfort. Similarly, if the treatment you can offer could reasonably be argued to keep the patient away from the hospital or reduce the cost of medication, FCC could be authorized. It is also important to note that some insurers have standard protocols for negotiation on a case-by-case basis.
Some have a “Pay At The Highest Rate”, as if you were a network provider. This is based on their tariffs without the need for negotiation. In an off-grid scenario like this, it`s possible to use a case-by-case agreement to ensure your client has the coverage they need to get the care they rely on from you as a practitioner or therapist. For such a scenario, the pricing policy can be evaluated on a sliding scale. Although you cannot charge your insurer the standard full rate for past repeat sessions. A case-by-case agreement is designed to meet the patient`s essential treatment or therapy needs and the cost benefits to the insurance company, without having to switch to another provider in the network. To lead the negotiation process, the following criteria must normally be met. These include the following factors: the client has tried and cannot find in their network a practitioner or provider that meets their needs in a way that allows them to feel comfortable.
In case of treatment with ABA, this should be done before the start of treatment. As it is inclusive, the agreement on a case-by-case basis We have already mentioned how you should focus on the services contained in the agreement. If your patient needs multiple treatments and therapies, the contract must cover reimbursement for billing for all or the maximum number of treatments. If you are a practitioner looking for 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. In this case, the negotiated rate may be influenced by the customer`s agreement. Although they need to be duly informed and may need to sign official documents indicating that they are aware of the process and may possibly cost more out of pocket. Sometimes an insurance company may have a “payment with the highest intra-network rate” policy, in which case you cannot negotiate the rate. You always have the option to refuse the SCA if the rate and conditions are not acceptable to you….