If you`re looking for information on “single case agreement Healthfirst,” you`re likely a healthcare provider or patient considering Healthfirst as an insurance provider. Single case agreements, also known as SCAs, are agreements between a healthcare provider and an insurance company for a specific patient who doesn`t have coverage under that insurer. Here`s what you need to know about single case agreement Healthfirst.

What is Healthfirst?

Healthfirst is a not-for-profit health insurance company based in New York City. They offer a variety of plans for individuals, families, and businesses. Healthfirst was established in 1993 and has since grown to serve over 1.4 million members.

What is a single case agreement?

A single case agreement is an agreement between a healthcare provider and an insurer that allows a patient to receive services despite not having coverage under that insurer. SCAs are typically used in cases where a patient needs a specific treatment or service that their insurance plan doesn`t cover. SCAs are usually only valid for a single episode of care, which means that a new agreement must be negotiated for each subsequent episode of care.

Single case agreements and Healthfirst

Healthfirst does offer single case agreements to providers who have patients in need of services that aren`t covered under their plans. The process for providers to request a single case agreement with Healthfirst is straightforward. Providers must submit a request for the agreement, including clinical information on the patient and the proposed treatment plan. Healthfirst will then review the request and notify the provider if the SCA has been approved.

It`s worth noting that single case agreements are not a guarantee of coverage. Healthfirst may decline an SCA request if they determine that the treatment or service is not medically necessary or if there are concerns about the patient`s safety or quality of care.

Conclusion

If you`re a healthcare provider or patient in need of a specific treatment or service that`s not covered by Healthfirst, a single case agreement may be an option. While Healthfirst does offer SCAs, they are only available in specific circumstances and are not a guarantee of coverage. As always, it`s essential to work closely with your healthcare provider and insurer to ensure that you receive the care you need.