Single Case Agreement (SCA) with Insurance for TMS Coverage

As a psychiatrist in private practice, I have chosen not to be a part of any insurance panel. More recently, our TMS Service has prompted the occasional use of a special type of contract with insurance companies, called a Single Case Agreement (SCA). We want to inform potential new patients about the SCA contract, which might help make TMS affordable if without current TMS coverage. A new patient who does not have out-of-network benefits can have their TMS covered through a SCA with their insurance company, which we will negotiate for you.


What is a Single Case Agreement (SCA)?

A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network TMS provider such as ourselves for a specific patient's treatment, so that the patient can have us perform their TMS using their in-network benefits. 

This process needs to be completed before commencing treatment. Once a SCA is established, our office works to negotiate our fee with your insurance company, which is generally based on customary rates listed by NYS Fair Health Law. This would then mean a patient pays only their routine in-network co-pays for sessions after meeting their in-network deductible (if any), just as if you saw an in-network provider.