If you or someone you know is in need of specialized medical care that is not covered by their insurance plan, a UnitedHealthcare Single Case Agreement (SCA) may be the solution.
What is a UnitedHealthcare Single Case Agreement?
A Single Case Agreement is an agreement between UnitedHealthcare, a health insurance provider, and an out-of-network healthcare provider. It allows the patient to receive medical care from the out-of-network provider at an in-network cost.
This type of agreement is typically reserved for patients who require specialized medical treatment that is not available in their network. It can also be used for patients who have a particularly strong relationship with their out-of-network provider and don’t want to switch to an in-network provider.
How Does a Single Case Agreement Work?
To request a Single Case Agreement, the patient or their healthcare provider must contact UnitedHealthcare and explain why the specialized treatment is necessary. This may include providing documentation of past treatment or a recommendation from a medical specialist.
Once the request is approved, UnitedHealthcare and the out-of-network provider will negotiate a fee for the services provided. The patient will then pay the negotiated fee, which will typically be lower than the out-of-network cost. The fee may also be subject to the patient’s deductible and coinsurance.
Who Can Request a UnitedHealthcare Single Case Agreement?
UnitedHealthcare Single Case Agreements are typically reserved for patients who require specialized medical treatment that is not available in their network. This may include patients with rare medical conditions or those who require treatment from a specialist.
It is important to note that UnitedHealthcare may deny a Single Case Agreement request if they believe that the treatment could be provided by an in-network provider or if they determine that the out-of-network provider is charging excessive fees.
What Are the Benefits of a UnitedHealthcare Single Case Agreement?
The primary benefit of a UnitedHealthcare Single Case Agreement is that it allows patients to receive specialized medical treatment that would otherwise be out of reach due to cost or lack of in-network providers.
It also allows patients to maintain a relationship with a trusted out-of-network provider, which can be particularly important for those with complex medical conditions.
In Conclusion
UnitedHealthcare Single Case Agreements can be a valuable tool for patients who require specialized medical treatment that is not available in their network. If you or someone you know is in need of this type of agreement, contact UnitedHealthcare to discuss your options and find out if you are eligible.