Fran Wickner,
Ph.D., MFT

The Business of Being a Therapist: What is involved in getting a “single case agreement" if a client has insurance and I am not on the panel?

A single case agreement is a contract between an individual patient’s insurance company and the treatment provider. It is for clients whose benefit plans do not include out-of-network benefits. A single case agreement allows a client to see a non-contracted professional utilizing their in-network benefit. You agree on the fee, the client pays the co-pay and you bill the insurance company.

You will be asked by the insurance company to explain your rationale as to why the individual’s treatment needs cannot be adequately met by one of the insurance company's in-network professionals. Insurance companies do NOT care about your relationship with the client, they care about behavioral changes, so saying "we have a connection" "transference" etc. will not work. Instead, state behavioral reasons justifying why they should see you. 

Here are some examples:

"The client's presenting problem is with substance abuse, I have ten years experience as a substance abuse expert".

"We have been working together for two months and her insurance changed to your company. I feel that it is best for the client to continue with me because she is dealing with stress at work and with the new fiscal year at her company coming up next month, there are so many changes that switching to a new therapist would be more than she can handle right now." 

"I have been working with this client for 12 weeks and her insurance just changed to your company. Her presenting problem is depression and the anniversary of her mother's death is coming up in the spring. I would like to continue with her until that date and then have time to terminate."

Insurance providers who offer single-case contracts will review potential agreements on a patient-by-patient basis. It’s important to note that the agreement is specific to the current episode of care and does not apply to care outside of this treatment episode.

After the insurance company agrees to let you see this client and what the fees will be, get it in writing. I try to have them email me the agreement immediately and also have the insurance company send me a hard copy.

You might also have to write a treatment plan to get more sessions. As mentioned above, make sure it is behavioral.

Fran Wickner, Ph.D., MFT has been a Licensed Marriage and Family Therapist since 1983. In addition to her clinical practice in Berkeley, Dr. Wickner is a practice building consultant and offers individual consultations and workshops as well as availability to speak to your consult group or professional association on all aspects of building and expanding your private practice. Website: FranWickner.com/ForTherapists