What Is a Single Case Agreement?
Finding a therapist who truly gets you is worth pursuing and more pathways exist to make it happen than most people realize.
If the therapist you want to work with isn’t in your insurance network, a Single Case Agreement (SCA) may be the bridge that gets you there. SCAs allow insurance companies to grant in-network benefits for an out-of-network provider which means you may be able to work with exactly the right therapist without paying out-of-pocket rates.
It’s one of the most underutilized tools in mental health coverage, and knowing about it can change everything. In this guide, we’ll walk you through how SCAs work and how to advocate for one so the right fit doesn’t have to mean the wrong price.
A Single Case Agreement is a temporary arrangement between an insurance company and a specific healthcare provider. In this arrangement, the insurance company agrees to cover services from a provider who is normally out of network.
For the duration of the agreement, the provider is treated as if they are in network for that one client and that specific service.
This means the therapist can bill the insurance company at a negotiated rate, and the client usually pays the same cost-sharing they would pay with an in-network provider. The agreement only applies to that individual situation. It does not mean the provider becomes permanently in network.
Insurance companies sometimes approve Single Case Agreements when they recognize that the care someone needs is not reasonably available within their existing network.
Why Single Case Agreements Exist
Insurance networks are designed to give people access to a range of providers. In reality, the experience can be more complicated.
Someone searching for therapy might discover that the providers listed in their insurance directory are not accepting new clients. Others may have waitlists that stretch for months. Sometimes the available therapists do not specialize in the type of care a person is seeking or needs.
These situations are more common than many people realize.
Single Case Agreements exist to address these gaps. If a client needs care and there is not an appropriate provider available in network, an insurance company may agree to work with an out-of-network therapist so the client can still receive treatment.
In this sense, a SCA is not an exception because someone prefers a certain therapist. It is usually approved because the insurance company recognizes that appropriate care is not realistically accessible through the existing network.
Situations Where Single Case Agreements May Be Considered
There are several situations where an insurance company might review a request for a Single Case Agreement.
1. Specialized therapy – Certain treatment approaches require advanced training and experience. For example, some therapists are specifically trained in Dialectical Behavior Therapy, trauma-informed therapy, or structured treatment programs that not every provider offers.
If someone needs a specific type of therapy and there are no qualified providers available within the network, an SCA may allow them to access that level of care.
2. Long waitlists – Even if providers technically exist within the network, they may not be available for many weeks or months. Insurance companies sometimes recognize that waiting this long is not reasonable when someone is actively seeking support.
3. Continuity of care – For example, someone may have already started therapy with a provider and then their insurance plan changes. Rather than interrupting the work they have already begun, the insurance company may approve a temporary agreement so therapy can continue.
How Does the SCA Process Work?
The process for requesting a Single Case Agreement can vary between insurance companies, but the general structure tends to be similar.
First, a need for care is identified. This may happen when a client finds a therapist who seems like a strong fit but learns the provider is out of network. It can also happen when someone searches their insurance directory and cannot find an appropriate provider who is available.
Next, a request is submitted to the insurance company. In many cases, this process works best when the client asks their insurance company first. Getting detailed information about your eligibility and requirements for SCAs will ensure your therapist can best support you with the process. Your therapist may need to meet with you to gather clinical information to help you determine if you are eligible for a single case agreement.
The insurance company then reviews the request. They may look at whether there are providers within the network who could reasonably offer similar care. If they determine that the network cannot meet the client’s needs, they may approve the agreement.
Once approved, the insurance company and provider agree on a reimbursement rate for services. The agreement typically lasts for a limited period of time or a set number of sessions.
For the client, the process often happens behind the scenes. The main experience is that their therapist is able to bill the insurance company as if they were in network for that period of care.
What a Single Case Agreement Usually Covers
Every Single Case Agreement is slightly different, but most include similar elements.
The agreement specifies the provider who will deliver treatment and the services that will be covered. It also outlines the reimbursement rate the insurance company will pay and the timeframe the agreement applies to.
Most agreements last several months or cover a specific number of therapy sessions. When the authorization period ends, the insurance company may review whether the agreement should be extended.
Because of this structure, SCAs are generally considered temporary arrangements rather than long-term contracts.
Insurance Coverage FAQs
Insurance can feel confusing even when you have used it before. Many clients have similar questions when they first hear about Single Case Agreements.
What Does Therapy Look Like Once Care Begins?
Insurance logistics are only one part of the process. What matters most is the experience of therapy itself.
The therapists at the Counseling Center Group draw from evidence-based approaches such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy, mindfulness practices, or Acceptance and Commitment Therapy. These approaches focus on helping people understand patterns in thoughts and emotions while building skills that make daily life more manageable.
Therapy always moves at a pace that feels collaborative and supportive. Some sessions focus on learning practical tools for managing stress or difficult emotions. Others create room to explore experiences and relationships with greater clarity.
For many people, simply having a consistent space where they can speak openly and feel understood becomes an important part of the healing process.
Key Things to Remember About Single Case Agreements
Single Case Agreements are not something most people plan for when they begin searching for therapy. They are simply one option that can help bridge a gap between insurance coverage and accessing the right care.
A Single Case Agreement is a temporary arrangement between an insurance company and an out-of-network provider. It allows the client to receive care at in-network coverage levels for a limited period of time.
Insurance companies usually consider SCAs when appropriate care is not reasonably available within their network. This might involve specialized therapy, long waitlists, or situations where continuity of care is important.
The request process often involves collaboration between the therapist, the practice, and the insurance company. While approval is not guaranteed, many clients find that exploring this option opens doors they did not know were possible.
Taking the Next Step Toward Support
Searching for therapy can bring up many practical questions, especially when insurance is involved. It is common to feel unsure about where to start or what options might be available.
If you are considering therapy and wondering whether a Single Case Agreement might apply to your situation, talking with a therapist or care coordinator can help clarify the possibilities. Even a short conversation can help you better understand what paths might exist for accessing care.
At Counseling Center Group, our team works with individuals navigating both the emotional and practical aspects of starting therapy. When possible, we help guide clients through insurance questions so they can focus more on receiving meaningful support.
If you would like to learn more about therapy options or explore whether a Single Case Agreement could be relevant for your insurance plan, we invite you to reach out for a free consultation. Ask to speak with one of our intake specialists or our customer support management to learn more.
You do not have to figure everything out on your own. Support is available, and the first step can simply be starting a conversation.
