What Is a Single Case Agreement? A Guide for Patients Seeking Home Health & DME Coverage
If your insurance plan doesn't include Contact Medical as an in-network provider, you might assume you're stuck paying full price out of pocket — or worse, going without the home health care or durable medical equipment (DME) you need. That's not always the case. There's a tool many patients don't know exists: the Single Case Agreement.
In this post, we'll break down what a Single Case Agreement is, when it makes sense, how the process works, and what to expect if you ask us to pursue one on your behalf.
What Is a Single Case Agreement (SCA)?
A Single Case Agreement is a one-time contract between an out-of-network provider — like us — and the referrer. It allows us to cover the services as if we were in-network, just for your specific episode of care, without requiring us to join their network permanently.
Think of it as a temporary bridge: your plan doesn't cover us broadly, but for your particular situation, we can agree to make an exception.
Why Would an Insurance Company Agree to This?
Insurers aren't in the business of saying yes just to be generous — they agree to SCAs when it makes sense for everyone involved. Common reasons include:
No in-network alternative. If there isn't another home health agency or DME supplier in-network that can meet your specific clinical needs, location, or timeline, the insurer may prefer an SCA over leaving you without care.
Continuity of care. If you're already receiving care from us — say, after a hospital discharge or a change in your insurance plan — interrupting that care could hurt your outcomes and cost the insurer more in the long run.
Cost efficiency. Sometimes an SCA at a negotiated rate is actually cheaper for the insurer than the alternative, whether that's a different provider or a preventable hospital readmission.
When Should You Consider Requesting One?
An SCA is worth exploring any time:
You've been referred to us but your plan lists us as out-of-network
You're switching insurance plans mid-treatment and want to continue care with the same team
You need specialized DME or home health services that aren't readily available in-network in your area
You're being discharged from a hospital or facility and need care to start quickly, before an in-network provider can be arranged
How the Process Works
Requesting a Single Case Agreement isn't something you have to figure out alone — our billing team handles it for you. Here's generally what happens:
We verify your coverage and confirm we're out-of-network for your specific plan.
We submit an SCA request to the referrer, along with clinical documentation supporting why care with us is appropriate — for example, urgency, lack of in-network alternatives, or continuity of an existing treatment plan.
The referrer reviews the request, which can take anywhere from a few days to a couple of weeks depending on the plan and urgency of your situation.
We follow up and negotiate terms if needed, including the agreed rate and scope of covered services.
You're notified of the outcome. If approved, we move forward with your care under in-network-level coverage. If it isn't approved, we'll walk you through your other options, including transparent self-pay pricing.
What If the SCA Isn't Approved?
Not every request is approved, and that's okay — you still have options. We offer clear, up-front self-pay rates for home health visits and DME with no hidden fees, so you can make an informed decision about how to move forward without surprises on your bill.
The Bottom Line
Insurance coverage isn't always black and white, and being out-of-network doesn't automatically mean coverage is impossible. A Single Case Agreement can be the difference between delaying care and getting started right away — and pursuing one costs you nothing but a conversation with our team.
If you've been referred to us and aren't sure whether your plan covers our services, reach out. We'll check your coverage, explain your options — including a Single Case Agreement or self-pay pricing — and help you get the care or equipment you need without the runaround.
Have questions about your coverage? Email us at info@contactmed.net or call us at (770) 858-5238 to speak with our Intake team.
This post is for general informational purposes and does not guarantee insurance coverage or approval of any Single Case Agreement. Coverage decisions are made by your insurance provider on a case-by-case basis.