Single Case Agreements (SCA's):
Question: What is a "Single Case Agreement?"
Answer: Insurance companies may opt to write a "Single-Case Agreement" in situations where they are obligated to have In-Network treatment providers who are capable of meeting your clinical needs, but simply do not have the providers in their network who can do so. In such a situation, you may request that your insurance company cover your clinician's services since you have not been able to find a provider in the insurance network who can meet your/your child’s specific and often specialized clinical needs.
Once a Single-Case Agreement has been signed, your insurer will agree to pay the clinician's full fee, minus any typical in-network co-payment. From your perspective, the payment to your clinician would end up being the same as if you were seeing an in-network provider, typically just the co-pay. For many patients who attend family therapy, group therapy, and individual therapy, the out-of-pocket expense savings for your family can be substantial.
Question: "Would I/my family member qualify if we have very complicated mental health issues and a large team of providers?"
Answer: A Single Case Agreement is more likely to be approved in situations where there is a high level of clinical acuity (recent in-patient hospitalization(s), a recent history of suicidal or homicidal behavior) or in situations where the clinical needs require the integration of a variety of specialized interventions such as school advocacy, the need for a specialized group, or coordination with a wide variety of professionals (DMH, DCF, Probation, Psychiatry, Special Education, Primacy Care Medicine, and/or Specialized Medical Personnel).
Question: "Would I be able to work with providers from Copernican Clinical Services?"
Answer: Staff at Copernican Clinical Services (CCS) are unable to write single case agreements with the in-network insurer networks that they are listed via CCS. As such, they are considered in-network if you worked with them via CCS. However, they may also be on staff at daVinci Behavioral Health, Inc (DBH). where they do have the ability to engage in single case agreements. DBH and Copernican Clinical Services are two, completely separate business entities. You would have to enroll with a DBH clinician as a DBH patient in order to be considered for a Single Case Agreement through DBH. You can ask your clinician for more details.
Solution: To establish a Single-Case Agreement you must contact staff at DBH to enroll as a DBH client. You can call 617-431-1441 or email firstname.lastname@example.org for more details. DBH administrative staff will be able to provide you with paperwork that will explain the process and help you understand how to advocate with your insurer to receive a Single Case Agreement.