Insurance & cost

Single case agreements: Getting insurance to pay for out-of-network rehab

Published December 29, 2024 · 7 min read · Updated April 2026

Reviewed for accuracy by licensed clinical professionals.

A single case agreement (SCA) is a one-time arrangement where insurance agrees to pay in-network rates for an out-of-network treatment facility.

When SCAs are granted

No in-network facility can meet your clinical needs (specialty services, geographic necessity). In-network wait times are excessive. Clinical continuity requires the specific out-of-network provider. You can demonstrate medical necessity for the specific facility.

How to request

Call your insurance's behavioral health department. Explain why in-network options are insufficient. Provide clinical justification. The treatment facility may help negotiate the SCA.

Tips

Be persistent. Document everything in writing. Escalate to a supervisor if initially denied. Have the treatment facility's admissions team help advocate.

Authoritative sources

This article references guidelines from: SAMHSA · NIDA · ASAM

Frequently asked questions

What is a single case agreement?

A one-time arrangement where insurance pays in-network rates for an out-of-network facility when in-network options are insufficient.

How do I get a single case agreement?

Call insurance, explain why in-network is insufficient, provide clinical justification, and have the facility help negotiate.

Are single case agreements common?

More common than most people realize. Insurance companies grant them when adequately justified.

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.