What is a single case agreement?

A single case agreement is a type of contract between an insurance company and a healthcare provider that specifies the terms and conditions for payment of services for a particular patient. In this agreement, the provider agrees to accept a predetermined rate for services rendered to the patient, typically lower than their usual fees, in exchange for being guaranteed payment by the insurance company.

Single case agreements are often used when a patient needs to see a provider who is not in-network with their insurance plan, or when the provider does not have a contract with the insurance company. These agreements allow patients to still receive care from the provider of their choice, while ensuring that the provider will be paid for their services.

Single case agreements are typically negotiated on a case-by-case basis and may involve additional paperwork and documentation to ensure that services are provided and billed correctly. Patients should be aware that they may be responsible for paying any difference between the negotiated rate and the provider's usual fees, as well as any applicable deductibles or co-pays.