Premera Single Case Agreement

Premera Single Case Agreement: What You Need to Know

Premera Blue Cross is a health insurance company that serves individuals and businesses in Alaska and Washington. If you have Premera Blue Cross coverage, you may be familiar with the term “single case agreement.” But what exactly does that mean? And how does it affect your healthcare?

In simple terms, a single case agreement (SCA) is a contract between an insurance company and a healthcare provider for the specific treatment of an individual patient. SCAs are typically used when a patient needs care that is not covered by their insurance plan, or when the provider is not in the patient`s insurance network. With an SCA, the insurer agrees to pay for the specific treatment from the out-of-network provider, as long as the provider agrees to accept the insurer`s payment rates.

Premera Blue Cross offers SCAs as a way to provide coverage for members who need specialized or out-of-network care. SCAs are typically used for services such as mental health treatment, substance abuse treatment, or rare medical procedures. In order to receive an SCA, the member`s treating provider must submit a request to Premera on their behalf. Premera will then review the request and determine if the SCA is appropriate.

It`s important to note that SCAs are not a guarantee of coverage. Premera may deny a request for an SCA if they determine that the requested treatment is not medically necessary, or if there are other in-network providers who can provide the same treatment. Additionally, an SCA does not waive any out-of-pocket expenses or deductibles that the member may be responsible for.

If you are a Premera Blue Cross member and your provider has recommended treatment that is not covered by your plan, you may want to consider requesting an SCA. Your provider can help you with this process and can provide documentation to support the request. Keep in mind that the process can take several days or even weeks, so it`s important to plan accordingly.

In conclusion, Premera Blue Cross offers single case agreements as a way to provide coverage for specialized or out-of-network care. SCAs are not a guarantee of coverage, and Premera may deny a request if they determine that it is not medically necessary. If you are a Premera member and are considering requesting an SCA, be sure to work closely with your provider and plan ahead to ensure that you receive the care you need.

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