WellCare Single Case Agreement: What It Is and How It Works

Are you in need of mental health services but having trouble obtaining coverage through your insurance provider? A WellCare single case agreement may be the solution you need.

A single case agreement (SCA) is a written contract between you, your therapist, and your insurance provider. It outlines the services you will receive, the cost of those services, and the agreement to cover those costs by your insurance provider.

WellCare is a managed care provider that offers health insurance plans including behavioral health services. If you are a WellCare member but your desired therapist is not in-network, a single case agreement with WellCare can allow you to continue seeing that therapist without incurring out-of-network costs.

To obtain a single case agreement with WellCare, you will need to follow these steps:

1. Choose your therapist: You will need to find a therapist who is willing to work with you and WellCare under a single case agreement. This therapist must have a license to practice in the state where you reside.

2. Provide information: Your therapist will need to document your need for their services and submit a request for a single case agreement to WellCare. This documentation may include a treatment plan, diagnosis, and progress notes.

3. Approval process: WellCare will review the request for a single case agreement and determine if it meets their criteria for approval. If approved, WellCare will provide written confirmation of the agreement and the cost of services.

4. Services provided: Your therapist will begin providing services outlined in the agreement, and WellCare will cover those services according to the agreement.

It is important to note that single case agreements are not guaranteed and may involve some negotiation between your therapist and WellCare. Additionally, not all therapists will be willing to work with insurance providers on a single case agreement basis.

However, if you are struggling to obtain mental health services through your insurance provider, a single case agreement with WellCare may be a viable option. It provides an opportunity for you to receive the care you need without incurring excessive out-of-pocket costs.

In conclusion, a WellCare single case agreement is a written contract between you, your therapist, and your insurance provider that outlines the services you will receive and the agreement to cover those costs by your insurance provider. It is a solution for those struggling to obtain coverage for mental health services and allows you to work with your desired therapist without incurring out-of-network costs. If you are considering a single case agreement with WellCare, it is important to find a licensed therapist who is willing to work with you and follow the necessary steps to obtain approval from WellCare.