Many insurance companies offer partial reimbursement for “out of network” providers. We are currently “out of network" providers but can provide a monthly receipt which you can submit to the insurance carrier for reimbursement. When you call your insurance company, you should ask:

What are my Out Of Network, Mental Health insurance benefits?

What is my deductible and has it been met?

How many sessions per year does my health insurance cover?

What is the coverage amount per therapy session?

Is preauthorization (e.g. pre-approval, pre-certification) required from my insurance company or primary care physician?

Am I able to use a health savings, flex spending, or other similar types of accounts to cover the cost of treatment?

We currently partner with the Network for Victim Recovery of DC (NVRDC) and offer sliding scale fees to survivors of domestic violence and sexual assault. We also offer reduced fees to families in need.

Maryland Single Case Agreement (SCA) for Psychotherapy

Maryland's Rule on Getting Specialized Care:

What's the Rule?

Insurance carriers must have procedures for members to get referrals to specialists even if these doctors aren’t on the company’s regular list. If the insurance company doesn’t have the right kind of doctor for your issue, or if seeing their doctor is too hard because of wait times or travel, you can see someone else.

Referrals are valid if the insurance carrier lacks an in-network specialist for a particular condition or can't provide reasonable access to one without causing the member undue delay or travel.

For billing purposes, services from these referred specialists will be treated as in-network.

Decisions by carriers to deny access based on medical necessity constitute an adverse decision.

Why would you need an SCA?

SCAs can be sought for various reasons, including:

Lack of specialized in-network providers.

Unavailability of in-network providers suitable for a patient’s specific needs.

Continuity of care after an insurance plan change.

Financial burden of out-of-network fees.

Absence of any in-network options for Medicaid and Medicare plans, especially for specific levels of care.

Understanding Single Case Agreement (SCA)

A Single Case Agreement (SCA) is essentially a special arrangement between an insurance company and an out-of-network provider. This allows a patient to use their in-network benefits with that provider. With an SCA, the patient typically pays their standard in-network co-pays, and the service fee is negotiated between the insurance and the provider.

Setting up a Single Case Agreement (SCA)

Initial Contact: Speak to your desired healthcare provider about the possibility of an SCA. You should be ready to discuss your medical background and any previous treatments.

Duration: SCAs generally span the treatment duration. For any subsequent treatments, you might need a new SCA.

Steps to Advocate and Set Up an SCA:

Reach Out to Your Insurance: Contact your insurance's member services (often the behavioral/mental health number on your card) to request in-network providers specializing in your treatment needs.

Explain the Situation: If no in-network providers are available, ask about out-of-network benefits. Mention if you've explored all available options and found none suitable.

Seek a Behavioral Health Case Manager: They are your internal advocates within the insurance company, linking you to in-network resources and aiding in SCA setups.

Research and Connect with Treatment Centers: Find centers that might consider an SCA with your insurance. Start with local facilities.

Collaboration: After finding a suitable center, they'll instruct you on the SCA process. Your outpatient providers can communicate with this center to support the need for an SCA, solidifying your case for "medical necessity criteria."

Remember, it's essential to stay persistent and keep communication lines open with your insurance, healthcare provider, and treatment center.

As an out-of-network (OON) practice, we do not have a contract with any insurance company. However, you may still be able to use out-of-network benefits to pay for services. When you get services from an out-of-network provider, you pay the entire cost of the session upfront. Then, you file a claim with your insurance company and they reimburse you for some of the money you spent. Filing a claim means filling out paperwork about the services you received and sending it to the insurance company. We will provide you with a document called a superbill to include with your claim. A superbill shows the insurance company exactly what kind of service you received.

Patients can submit claims to their insurance company either by mail or online through the insurance company's website. We recommend the online submission method as it provides an easier way to track and receive updates on the status of the claim. When completing the online submission, patients will be required to upload their superbill, ensuring that all necessary details are included for a streamlined and efficient reimbursement process.

Need Help Submitting a Claim?:

www.Reimbursify.com

Reimbursify is a new platform that aids the process of submitting insurance claims for patients by empowering them to effortlessly self-file for out-of-network medical and mental health insurance reimbursement in as little as 10 seconds, providing a seamless and efficient solution for claim submissions.