Aetna Single Case Agreements: What They Are and How to Get One

When it comes to healthcare, it’s important to have options. But what happens when your preferred provider doesn’t accept your insurance? That’s where Aetna Single Case Agreements (SCAs) come in.

SCAs are agreements between Aetna and healthcare providers that allow patients to receive care from an out-of-network provider at an in-network cost. This can be a lifesaver for patients with rare conditions or specialized needs who don’t have access to in-network providers.

So, how do you go about getting an SCA?

The first step is to determine if your provider is willing to participate in an SCA. You can contact your provider’s office directly or work with Aetna to request an SCA on your behalf. Keep in mind that not all providers will be willing to enter into an SCA, so it’s important to have a backup plan.

Once you’ve identified a willing provider, you’ll need to provide some basic information to Aetna to begin the SCA process. This includes your name, insurance policy number, and the name and contact information for your healthcare provider.

Aetna will then review your request and determine if an SCA is warranted. Factors that may influence their decision include the availability of in-network providers and the complexity of your health needs.

If your request is approved, you’ll receive an SCA from Aetna that outlines the terms of the agreement, including the services covered and the cost you’ll be responsible for. Be sure to review this document carefully and ask any questions you have before proceeding with care.

It’s important to note that SCAs are temporary agreements that typically last for a specified period of time (e.g. 6-12 months). If you need ongoing care from an out-of-network provider, you may need to request a new SCA at the end of the initial agreement.

In conclusion, Aetna Single Case Agreements can be a valuable tool for patients who need specialized care from out-of-network providers. By following a few simple steps, you can work with Aetna to secure an SCA and get the care you need.