Insurance Single-Case Agreement

7/5/2024

Understanding Single-Case Agreements
A single-case agreement (SCA) is a special contract between an insurance company and a provider who is not in the insurance network. This agreement allows the provider to deliver services to a specific patient with the insurance covering the costs, despite the provider being out-of-network. SCAs are often used when the required services are not readily available within the network or when a patient has a unique need that can be best addressed by a specific provider or specialist.

In Arizona, there is no licensure option for pastoral counselors like there is in other states, making the process more challenging since many insurance companies will only cover services from state-licensed counselors. However, some insurance companies will cover these services if there is a clear medical necessity. Examples of such medically necessary conditions include severe grief, marital or family conflicts, crisis intervention, chronic illness, and end-of-life issues. These services are often considered necessary when they intersect with spirituality and faith, addressing both mental health and spiritual needs.

At Prism Counseling & Coaching, all of our pastoral counselors are board certified by a national organization, which may also help in securing an SCA. Board certification ensures that our pastoral counselors meet high educational, clinical, and ethical standards of practice, and have professional oversight and accountability, which can be persuasive in demonstrating the necessity and quality of care to insurance companies.

Steps to Secure a Single-Case Agreement

1. Consult with Your Insurance Provider

Contact your insurance company: Start by calling the customer service number on the back of your insurance card.
Inquire about SCAs: Ask if your insurance company offers SCAs for faith-based counseling services.

2. Gather and Submit Necessary Documentation

Referral from your doctor: Some insurance companies may require a referral from your primary care physician.
Letter of medical necessity: Obtain detailed letters explaining the necessity of the counseling services from both your counselor and your doctor. These should include:
- A clear reason for the counseling services.
- Explanation of how the services address specific mental, emotional, and/or spiritual needs.
- Justification for why pastoral or faith-based counseling is imperative.
- Explanation of the pastoral counselor's credentials from the pastoral counselor.
Submit the detailed letters to your insurance company.

4. Follow Up

Regular communication: Maintain regular contact with your insurance company to check the status of your request.
Advocate for your needs: Be prepared to explain why these services are essential for your well-being.

Tips for a Successful Request

Be specific: Clearly outline why faith-based counseling is necessary for your care.
Be persistent: Follow up regularly and be prepared to provide additional documentation if needed.
Seek support: Your counselor and your doctor can be strong advocates, providing necessary information and backing up your request.

If Your Request is Approved
Once your single-case agreement (SCA) is approved, you can begin your counseling sessions with peace of mind, knowing that your insurance will cover the costs. Here’s what you can expect:

Direct Billing: Your counselor will bill your insurance company directly for the approved sessions under the SCA. This means you won't need to handle the billing process yourself.
Insurance Payments: The insurance company will process the payments according to the terms of the SCA, covering the agreed-upon costs.

Disclaimer: The information provided here is intended to help you understand the process of securing a single-case agreement (SCA) for pastoral counseling services. However, we cannot guarantee that following this guidance will result in coverage, as each insurance company has its own policies and criteria. We cannot guarantee any outcomes on behalf of any insurance company. For the most accurate and personalized information, please contact your insurance provider directly.

Insurance Single-Case Agreement

Steps to Secure a Single-Case Agreement

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