Single Case Agreement Insurance: What You Need to Know

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Single Case Agreement Insurance: What You Need to Know

The rising cost of healthcare is leading many patients to look for alternative insurance options such as single case agreements. The most important thing to understand about this type of insurance is what it covers, how it works, and whether it is right for you. We will cover everything you need to know about single case agreements in this article.

What is Single Case Agreement Insurance?

Single case agreement (SCA) insurance is a type of insurance where an insurance company agrees to cover the cost of specific medical treatments for a patient on a case-by-case basis. It is often used when an existing insurance plan does not cover a patient’s treatment.

How Does Single Case Agreement Insurance Work?

When a patient needs a treatment that is not covered by their insurance plan, their doctor can request a single case agreement from the insurance company. Afterward, the insurance company will review the request and decide whether to approve it.

Upon approval, the insurance company will cover the specific treatment or services outlined in the agreement. If the patient requires further treatment, the agreement must be renewed. Coverage usually lasts for the duration of the treatment.

Advantages of Single Case Agreement Insurance

Single case agreement insurance has several advantages, including:

Access to Treatments Not Covered by Standard Insurance Plans

The main advantage of single case agreement insurance is that it provides access to treatments that may not be covered by standard insurance plans. Patients with rare or complex medical conditions may benefit from this.


As it is tailored to the specific needs of the patient, single case agreement insurance offers flexibility in terms of coverage. It can be particularly helpful for patients who need treatments that are outside the scope of traditional medicine.

Personalized Care

As single case agreement insurance is tailored to the patient’s needs, it can provide a more personalized experience. Patients may feel more comfortable and confident in their treatment plan as a result.

Disadvantages of Single Case Agreement Insurance

There are many advantages to single case agreement insurance, but there are also some potential disadvantages, including:

Limited Coverage

The coverage under a single case agreement is limited to the specific treatments outlined in the agreement. As a result, patients may not have coverage for other medical expenses not covered by the policy.

High Costs

A single case agreement insurance plan is tailored to the specific needs of the patient, so it may be more expensive than a traditional insurance plan. Before choosing this option, patients should carefully consider the costs and benefits.

Limited Provider Networks

Patients may have difficulty finding providers who accept single case agreement insurance because of limited provider networks.

Is Single Case Agreement Insurance Right for You?

Your specific healthcare needs and financial situation will determine whether single case agreement insurance is right for you. When making this decision, consider the following factors:

Your Medical Needs

The single case agreement insurance may be a good option for you if you have complex medical conditions or need a treatment not covered by standard insurance plans.

Your Budget

If you have trouble affording traditional insurance plans, then you may want to consider single case agreement insurance.

Provider Networks

It is important to make sure your preferred healthcare provider accepts single case agreement insurance before enrolling.


Patients who need treatments not covered by standard insurance can benefit from single case agreements. Despite some disadvantages, this type of insurance can provide access to customized healthcare. When considering single case agreement insurance, make sure you carefully compare the benefits and costs.


Common Questions About Single Case Agreement Insurance

What types of treatments are typically covered by single case agreement insurance?

The purpose of single case agreement insurance is to cover treatments that are not covered by standard insurance plans, such as experimental treatments, out-of-network providers, or medications not approved by the FDA.

Is single case agreement insurance available to everyone?

Patients with specific medical conditions that require treatments that aren’t covered by their existing insurance usually qualify for single case agreements.

How do I request a single case agreement from my insurance company?

It is usually necessary for your doctor to submit a request for a single case agreement on your behalf. A decision will be made by the insurance company regarding the request.

How long does a single case agreement last?

The duration of a single case agreement usually corresponds to the specific treatment outlined in it. Depending on the patient’s needs, the agreement may need to be renewed.

How can I find out if my preferred healthcare provider accepts single case agreement insurance?

If you want to know which providers accept single case agreements, you can contact your healthcare provider directly or contact your insurance company.