Protecting Continuity of Care: SCA Success for Long-Term PTSD Treatment

An Unwrapped client requested that The Phia Group secure a Single Case Agreement (SCA) for a patient undergoing long-term treatment for post-traumatic stress disorder (PTSD). The patient had been receiving weekly care from an out-of-network mental health provider for over a year. With the patient’s current coverage nearing expiration, the need for a prompt and seamless resolution was critical to avoid any lapse in care.

 

While requests for SCAs are not uncommon, mental health cases—particularly those involving long-standing therapeutic relationships—require individualized attention and urgent care. In this case, the patient had built strong rapport with the provider and was showing progress. Interrupting care posed a significant risk of decompensation.

 

Phia began by conducting a thorough review of the diagnosis codes, CPT codes, and place of service. Based on this analysis, Phia developed a benchmark report that the Plan could use to outline a reasonable per diem rate to help guide the negotiation. As with all high-touch cases, Phia ensured alignment with the client’s needs before initiating discussions with the provider.

 

With strategy and expectations aligned, Phia promptly invited the provider to submit a proposed rate. Both the provider and the Plan responded quickly and collaboratively worked toward a resolution that reflected both the value of the services and the importance of care continuity.

 

By partnering with The Phia Group, our client was able to have a finalized SCA completed within 8 business days of the original request. The patient experienced no disruption in treatment, and the Plan achieved a swift, cost-effective resolution with a trusted provider.