Molina Single Case Agreement

If you receive a CSA for an ongoing patient for further treatment, the negotiated price will be based on the patient`s informed agreement and agreement when they begin treatment with you. Rate increases are consistent with your pricing policy in informed consent. You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. If the patient has recently switched insurance providers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B 60 days since the insurance change) to allow the patient to continue treatment with the current network provider while switching to a network provider. If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. Examples: a patient has an uncertain bond and finds it very difficult to trust others. The therapeutic relationship already established with the current supplier can be considered as a factor in granting the SCA.

It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network. In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. Sometimes an insurance company may have a “payment policy with the highest in network rate,” in which case you will not be able to negotiate the rate. You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. 4. for exemptions in the part of the agreement entitled “Non-participating supplier in a participating supply organization.” If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the out-of-network provider before the start of treatment. 1.

For emergency services covered in the “Emergency Services and Urgent Care Services” section of the agreement, Contact Covered California at (800) 300-1506 or see CoveredCA.com to: A single case agreement (CAS) is a contract between an insurance company and an external network provider for a given patient; so that the patient can see that the provider is using its services on the network (i.e. the patient must pay for his routine in-network co-country for the sessions only after completing his network deductible (if any). The per meeting fee paid by the insurance company is negotiated by the insurance company and the supplier under the CSA. The treatment you are doing will keep the patient away from the hospital or reduce the cost of the medication Yes. You can select another health plan for a start date on January 1st until December 15th. Please go to Covered California to check your plan options.