Single Case Agreements in 2025: A Simple Guide for Therapists and Patients

If you work in therapy or behavioral health, insurance paperwork can feel confusing. You might hear people talk about "out-of-network" or "SCA" and wonder what it all means for your practice or your wallet.

In 2025, Single Case Agreements are becoming more popular, especially for specialized services like ABA therapy. This guide breaks down everything you need to know about SCAs in plain English.

What Exactly Is a Single Case Agreement?

A Single Case Agreement (SCA) is a special contract between an insurance company and a therapist who doesn't normally work with that insurance.

Think of it this way: When a therapist is "out-of-network," patients usually pay much more out of pocket. An SCA changes this. It lets the patient see their chosen therapist while paying the lower costs they would pay for an in-network provider.

Here's what makes SCAs unique:

• They're made for just one patient at a time

• They usually last between six and twelve months

• They cover specific types of therapy services

• They're temporary solutions for special situations

When Do You Need an SCA?

Insurance companies don't create SCAs for everyone. They typically approve them in three main situations:

While Waiting for Network Approval

This is the most common reason. When a therapist applies to join an insurance network, the paperwork can take months. An SCA lets the therapist start seeing patients right away instead of making them wait.

Keeping the Same Therapist

Sometimes a patient switches jobs and gets new insurance. But they're making real progress with their current therapist. An SCA helps them continue treatment without starting over with someone new.

Finding Specialized Help

Some patients need specific types of therapy that aren't available from nearby in-network providers. For example, certain ABA therapy services require special training. If no one in the network can provide this care, an SCA bridges the gap.

Understanding the Money Side of SCAs

Payment is often the biggest concern for both therapists and patients. Let's break down what actually happens with SCA rates.

How Payment Works for a Single Case Agreement

When a therapist is out-of-network without an SCA, patients often pay full price and then wait for partial reimbursement. With an SCA, the insurance company agrees to pay the therapist directly at a negotiated rate.

What Therapists Can Expect in 2025

Recent data shows some important trends:

• Rates vary widely. Some therapists negotiate rates that are higher than standard network rates. Others end up accepting much less.

• Payment can be unpredictable. Some insurance companies pay only 40% of what therapists initially request.

• Location matters. The same service might get paid differently depending on where you practice.

• Medicaid has its own rules. For patients with Medicaid managed care, rates usually match the state's standard fee schedule unless you negotiate strongly.

The key takeaway? Negotiation skills matter a lot. Therapists who know what to ask for—and have records of past SCA rates—tend to get better deals.

Common Problems with SCA Billing

Even though SCAs solve many problems, they create some challenges too. Understanding these issues ahead of time can save you frustration down the road.

Slower Payments

Claims under an SCA often take longer to process than regular in-network claims. Insurance companies need extra time to verify the special agreement.

Here's why: Regular in-network claims are processed automatically through computer systems, usually within two to three weeks. But SCA claims require human reviewers who must pull up the specific agreement, confirm service dates fall within the SCA timeframe, and verify billing codes match negotiated rates.

This manual review can stretch payment timelines to 45-90 days. The delay gets worse if there's confusion about agreement terms or if the claims department can't quickly locate the SCA in their system.

What you can do: Submit a copy of the signed SCA with your first claim. Include a cover letter referencing the agreement number and approval date. Follow up after three weeks if you haven't received payment.

Extra Paperwork

Before treatment starts, both parties must sign the agreement. While the final SCA might be one page, getting there requires significant work.

The full process typically involves:

• Initial request with diagnosis documentation, proof of network inadequacy, credentials, and proposed rates

• Negotiation rounds as the insurer counters your proposal

• Detailed agreement specifying patient info, provider details, exact dates, CPT codes with rates, session limits, and conditions

• Multiple signatures from various departments

• Distribution to claims processors, provider relations, billing staff, and care coordinators

Missing even one small detail—like using the wrong NPI number—can cause every claim to be rejected.

What you can do: Create a checklist of required information. Keep a master file for each SCA with all correspondence and documents. Set calendar reminders 30 days before expiration to start renewals early.

Inconsistent Rules

Different insurance companies handle SCAs completely differently, making standardization impossible.

The inconsistency appears everywhere:

• Approval criteria: One insurer readily approves specialized therapy SCAs; another requires proof of three failed in-network attempts first

• Rate transparency: Some publish fee schedules; others offer unexplained rates

• Documentation: Requirements range from simple emails to 10-page applications

• Duration: Some approve 12 months; others only 3 months with monthly reports

• Renewals: Some auto-send paperwork; others require starting over

• Claims process: Attach SCA to each claim, submit normally, or use special codes—it varies by insurer

This forces billing staff to learn each company's quirks rather than following one standard process.

What you can do: Create a reference guide documenting how each insurer handles SCAs, including contacts, forms, timelines, and billing instructions. Update it regularly. Consider partnering with billing specialists who already know these details.

Need expert help with SCA billing and negotiations? Contact Cube Therapy Billing for a free consult and see how we can simplify your workflow.

Getting Help with SCA Management

Because SCAs involve so much variation, many therapy practices struggle to handle them alone. This is where specialized billing help becomes valuable.

What Good Billing Support Looks Like

Professional billing companies that understand SCAs can:

• Negotiate better rates on your behalf

• Handle all the paperwork correctly the first time

• Follow up on delayed payments

• Track which billing codes work best for each insurer

• Keep records that help with future negotiations

Research shows that practices using expert billing support get paid on the first claim submission more often. They also spend less time dealing with insurance headaches.

Tips for Therapists Working with SCAs

If you're a provider considering SCAs, keep these points in mind:

Start the conversation early. Don't wait until a patient needs an appointment. Begin talking with insurance companies as soon as you know there's a need.

Keep good records. Save copies of every SCA you sign and track what rates you received. This information helps you negotiate better terms next time.

Know your worth. Research what other providers in your area charge for similar services. Don't automatically accept the first rate offered.

Get it in writing. Never start treatment based on a verbal promise. Always wait for the signed agreement.

Set clear expectations with patients. Make sure patients understand that the SCA is temporary and explain what happens when it ends.

What Patients Should Know

If you're a patient who might need an SCA, here's what to remember:

• Ask questions. If your insurance company suggests an SCA, ask how long it will last and what happens afterward.

• Check your benefits. Even with an SCA, some costs might not be covered. Know what you'll pay out of pocket.

• Plan ahead. If your SCA is about to expire, start planning your next steps early. You might need to switch providers or extend the agreement.

• Keep documentation. Save all letters and agreements from your insurance company. You might need them later.

Looking Ahead: The Future of SCAs

As healthcare continues to change, SCAs are becoming more common. More patients are seeking specialized therapy services, and network gaps still exist in many areas.

Some experts are calling for clearer rules around SCA rates and processes. Until those changes happen, both providers and patients need to stay informed and work with knowledgeable partners.

Your Next Steps

Understanding Single Case Agreements doesn't have to be overwhelming. Whether you're a therapist building your practice or a patient seeking care, knowledge is power.

For therapists, consider whether handling SCAs on your own is the best use of your time. Expert billing support can free you up to focus on what you do best—helping your patients heal and grow.

For patients, don't be afraid to ask your therapist or insurance company to explain the SCA process. You deserve clear answers about your coverage and costs.

The most important thing to remember is this: SCAs exist to help people get the care they need. When handled correctly, they benefit everyone involved.