Single Case Agreements (SCAs) between healthcare providers and insurance companies have become increasingly popular in recent years. An SCA is a contract between a healthcare provider and an insurance company that allows for the treatment of a patient outside of the insurance company`s network. This type of agreement can be beneficial for patients who require specialized treatment that is not readily available within their insurance network.
One insurance company that offers SCAs is UMR. UMR is a third-party administrator (TPA) that provides healthcare benefits management services to self-funded employers. UMR offers SCAs to its clients, which can be an attractive option for individuals who need specialized care or are seeking treatment from a provider outside of their network. However, it`s essential to understand the specifics of UMR`s SCA policy before entering into an agreement.
One important thing to note is that UMR`s SCA policy only covers services that are not available within their network. This means that patients must first attempt to receive treatment from a provider within the UMR network before seeking an SCA. Additionally, UMR`s SCA policy only applies to services that are deemed medically necessary and appropriate by UMR`s medical management team.
Another critical component of UMR`s SCA policy is the process for obtaining approval for an SCA. Patients must work with their healthcare provider to submit a request for an SCA to UMR`s medical management team. This team will then review the request and determine whether the requested services are medically necessary and appropriate. If the request is approved, the patient and provider can move forward with treatment under the terms of the SCA.
It`s also important to note that UMR`s SCA policy only covers the specific services outlined in the agreement. Any additional services or treatments will not be covered under the SCA and will be subject to the patient`s regular insurance coverage.
In conclusion, UMR`s Single Case Agreement policy can be a useful option for patients who require specialized treatment outside of their network. However, patients and healthcare providers must understand the specifics of the policy and follow the proper procedures for obtaining approval. Additionally, it`s important to note that an SCA only covers specific services and may not cover additional treatments or services outside of the agreement.