Ted Lasso (the TV show and the character) has found the ideal way to get therapy fast and cheap: Whenever Ted needs some advice, a new perspective, or is struggling with something, he gets up, and pensively walks to the building across the street where the team’s in-house therapist is waiting and available. Ted has a spontaneous, productive session and receives invaluable advice from an expert. I wonder what that’s like?
Sadly we can’t all be Ted Lasso. At a moment’s notice, Ted gets expert help from his employer’s in-house therapist. There’s no back and forth billing nightmares. There’s no calling to make an appointment six months out. Clearly easily accessible therapy is one of the many perks of being in a professional soccer organization (nope, I’m from Indiana, I will not call it football)!
Obviously, Ted is in a fictional world and the rest of us aren’t. The closest we can get to finding out-of-network therapy as smoothly as Ted does is with something called Single Case Agreements (SCA’s).
What Are SCA’s?
Before I get to Single Case Agreements (SCA's), step one to saving money on therapy is to work with an in-network therapist. Every insurance plan has a network of providers. Working with an in-network provider means you get discounted rates for services, whereas out-of-network means you have to pay for everything out-of-pocket. Basically, in-network﹦$, out-of-pocket ﹦ $$$$. Single Case Agreements (SCA’s) are agreements between your healthcare provider and your insurance that let you receive out-of-network care at the in-network price.
SCA’s are a great hack to seek doctors not in your network and only have to pay as if they were in your network. It’s by no means a guarantee, but insurance companies will often comply with requests to negotiate SCA’s on your behalf. When you get an SCA, they do all the work and you get all the perks. Sometimes insurance can be nice.
When Are SCA’s Used?
Say you are working with a therapist that you really like. Awesome! But then they decide to stop taking insurance (not awesome), which unfortunately, happens often. At this point you have two options: (1) pay out-of-pocket to see your same therapist ($$$$) or (2) go find another. For most people, finding a therapist is a lot like dating. It can be hard to find a therapist you click with, who is close by, and works for you. Say in your search for a new one, you go to four different therapists that don’t work. That’s a lot of money for your insurance company to pay for sessions with minimal value. It’s in their interest (and yours!) if you can stay with your existing therapist. Enter the SCA.
To be able to continue to see that same therapist without suddenly having to pay for it all yourself, you can ask for a SCA. SCA’s are normally used when a patient has a condition that cannot be treated by an in-network provider. Aren’t SCAs handy? There’s just one problem, and a big reason why you haven’t heard of them: there is no SCA button on your insurer’s website or mobile app. Go ahead, try to find it. I’ll wait.
Because of the work required to negotiate an SCA, most insurance companies don’t advertise this to their members. If you want to take advantage of an SCA, you’re going to have to advocate for yourself. Here’s how.
How To Get An SCA
So first you’re going to need a phone. (The kind you use to call people, like talking to another human. You know, calling.) The steps below work for any specific condition, not just mental health-related:
Step 1: You need to prove that your in-network options can’t give you the care you need and that an out-of-network provider can. In this example, you can argue that a new-to-you therapist cannot provide the same level of care that your seasoned, trusted therapist is already giving you.
Step 2: Once you’ve found an out-of-network option, you want to call them and ask if they will consider working under a single case agreement. In this example, you would talk to your existing therapist and confirm that they are willing to work under a single case agreement.
Step 3: If that provider is interested, then call your insurance company and request that you initiate a single case agreement process.
Even though it’s only three steps... that’s a lot of calling and navigating bureaucracy. Luckily, I’ve got a “phone script” below to help you out when it comes to talking to your insurance company. Remember: calling the out-of-network provider is easier, since they have a clear incentive to help you, it’s the insurance company that requires a specific approach. If it helps, think of Ted. He’s the kind of guy who never takes “no” for an answer—and he does it all while smiling.
Provider Script
Talking to your provider is the easy part! But just in case you’re really unsure how to broach the topic, try something like this:
“Since you are no longer taking my insurance, would you be open to an SCA with my insurance?”
Insurance Company Script
Call your insurance’s company on their help/questions line. Then state:
“I’d like to request a Single Case Agreement to see a specialist out of network for [INSERT CONDITION HERE.] I called around, and wasn’t able to identify a specialist in-network who can help me with my condition and I cannot afford the out-of-network costs.
One provider, [INSERT PROVIDER NAME HERE] did let me know they can provide the treatment and will consider a single case agreement. How should I proceed?”
Worst Case, Best Case Scenario
I know, the above script sounds like you’re getting ready to battle with Comcast to lower your internet bill, but insurance providers want to provide effective care to their members. You never know what can happen if you just ask about Single Case Agreements. The worst case scenario is that you learn a lot about your treatment options near your home. Best case, you get the care you need at a rate you can afford.
So, you’re not Ted Lasso. But you can get great mental health care like he does!