Many of our clients who are not members of participating insurance plans have obtained single case agreements (SCA) from their insurance company, which allow OON insurance clients to get services at CAASS at in-network terms. We have had a high success rate obtaining SCA from most insurance plans (except United Healthcare/UHC and UMR*) that are regulated by the state of Ohio** for clients with suspected or diagnosed Autism.
Please contact CAASS for more information on how to request a single case agreement from your insurance company. An excellent explanation of single case agreements from Vinodha Joly, LMFT can be here.
CAASS will courtesy bill all most out-of-network (OON) insurance companies for our clients. This saves the client from having to file paperwork with their insurance company. If you have a PPO or POS printed on your insurance card, you likely have out-of-network benefits. Please see our fee policy about billing OON.
Medicare and Secondary Insurance
CAASS cannot accept Medicare for regulatory reasons. This includes persons who have both Medicare/Medicaid unless the client has pre-authorization.
CAASS will not bill secondary insurance (e.g. you have Medicare as your primary insurance and say Anthem as your secondary). CAASS will provide you with any information (superbills, Form 1500, etc.) you need to make claims to secondary insurance.
*UHC and UMR have not been approving any SCAs as of late as they claim to have plenty of providers in-network that can help adults with Autism. If you believe that the list of in-network providers is not accurate you can report this to the Ohio Department of Insurance.
**Some insurance plans are regulated by the federal government, including most employer funded plans. These federally regulated plans have been more difficult to get SCA’s from.