If you receive a CSA for an ongoing patient for further treatment, the negotiated price will be based on the patient`s informed agreement and agreement when they begin treatment with you. Rate increases are consistent with your pricing policy in informed consent. You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the out-of-network provider before the start of treatment. What needs to be taken into account when approving individual case agreements, if you get approval of an agreement on a case-by-case basis, can be a tedious and frustrating task. Our mission is to help you. However, if the SCA has been approved, our task is not complete. Here, we need your help to take into account the following aspects: If the patient has recently changed insurer, the insurance can accept a limited number of sessions (about 10) and a period (for example. B 60 days after the insurance change) so that the patient can continue treatment with the current network provider as he switches to a network provider. If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. Examples: a patient has an uncertain bond and finds it very difficult to trust others. The therapeutic relationship already established with the current supplier can be considered as a factor in granting the SCA.
What are the conditions that patients must meet in order to reach an agreement on a case-by-case basis? To obtain a case-by-case agreement, you, as a health care provider, must commit to billing your patient with the insurance company. The goal of the SCAs is to meet the important needs of the patient; billing costs a network provider more than a network provider. The following conditions call into question your patient`s case for an CAS: One thing to consider is that insurance companies are legally required to provide patients with appropriate treatment by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network.