One thing to keep in mind is that insurance companies are legally required to properly treat patients by properly trained professionals. Therefore, if the insurance plan does not cover out-of-network services and there are no networked providers with the indicated specialization, you can, as a trained provider, negotiate your usual full meeting fees for new patients. This is because the patient does not simply choose to see you, but is forced to do so with insufficient network providers. In this case, the patient usually asks the insurance for an ACS with you before starting treatment. 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. As an ABA therapy provider, you may want to consider negotiating a single case agreement (SCA) to offer services to a patient. These agreements are concluded between insurance companies and out-of-network service providers (OON) with which the OON Agency is recognized as an in-network network provider (DSD). While it is usually the patient who requests SCA from their insurer, based on the absence of other DNS providers for ABA therapy in their area, your agency should always agree on the terms and rates of the services provided. Since insurers are not legally required to provide an ACS, it is important that you present them with the benefits of this possibility.
Remember, however, that you remain honest and justified about the justification for the need for A.A. To embellish is to deceive. The ACS application generally falls into two categories: the new client or the current patient. If you are trying to get an ACS for a new patient, you need to consider the needs of the patient (family) in your specialty and the advantage of being close to them. If you are helping a current patient apply for an ACS from a new insurer, you justify the need for the agreement by emphasizing continuity of care. Also remember that you must have defined your patient`s financial responsibilities to your agency until an ACS is issued. You can decide not to provide services until the FCC has been authorized, or you can agree on a financial agreement for meetings that are not covered by the agreement (just because an A.A. is authorized does not mean it will be demoted). Always ask for an SCA for OON plans for which you want to obtain permission. Consider the following strategies to get an agreement on a case-by-case basis: If the patient has not had a chance to find a sufficiently qualified network provider, the patient advocates for AA with the out-of-network provider before starting treatment. If you receive an ACS for a current patient for continued treatment, the negotiated rate is based on the patient`s informed consent and consent at the start of treatment with you. Rate increases will be consistent with your pricing policy in informed consent.
You can`t charge the patient a lower mobile rate out of pocket and then charge the insurance company your normal full rate if the SCA is dated back to cover past sessions. . . .