Single Case Agreements for Mental Health Treatment
When your plan has no in-network program that fits, it may agree to cover Wings for your case. Admissions makes the request and tells you plainly what your plan decides.
An agreement between Wings and your plan, for your care
Insurance plans have to give you access to the care you need. When they have no in-network program that can provide it, they can agree to cover a provider outside their network, one case at a time.
Your insurance
Your plan
Single case agreement
Covers your care at Wings
The provider
Wings
For one person
The agreement covers your treatment only, between Wings and your plan.
Often on in-network terms
Many agreements use your in-network cost share. The terms depend on the agreement.
Not guaranteed
Your plan decides. Admissions tells you plainly where it stands.
When a single case agreement may be possible
These are the most common reasons a plan agrees to one. Admissions looks at your situation and your plan.
No in-network program fits
Your plan has no in-network residential, PHP or IOP program for what you need.
No space in time
In-network programs have long waits, and you need care now.
HMO or EPO plan
Your plan has no out-of-network benefits, so an agreement may be the way to cover Wings.
A specific clinical need
Such as trauma-focused care or a program only for men or only for women.
Stepping down from a hospital
You are leaving an inpatient stay and need the next level of care without a gap.
Leaving a psychiatric hospital?
After a hospital stay
Admissions makes the request, so you do not have to
- 1
Verify your insurance
Admissions checks your benefits and whether your plan has an in-network option for your needs.
- 2
Clinical assessment
It documents the level of care you need, which your plan uses for medical necessity.
- 3
Admissions asks your plan
They contact your plan’s case manager and request a single case agreement for Wings.
- 4
You hear the answer
If your plan agrees, admissions explains the terms and what you may owe before you start.
Call early, especially from a hospital
How long an agreement takes depends on your plan. Starting early gives admissions time for the assessment, the records and the request, so there is no gap in care. Admissions keeps you updated along the way.
Other ways to pay for treatment
PPO plans
Out-of-network benefits
Many PPO plans pay a share of treatment outside their network.
Learn more
Without insurance
Private pay
What drives the cost of treatment, and what admissions can explain about paying privately.
Learn more
Not accepted
Medi-Cal and Medicare
Single case agreements are for private plans. For Medi-Cal or Medicare, admissions can point you to programs that accept them.
Wings works with many PPO insurance plans
Admissions verifies your benefits before admission, free and confidential. For Medi-Cal or Medicare, admissions can point you to programs that accept them.
Questions about single case agreements
What it is, when it applies, who asks, timing, cost and what happens if your plan says no.
Don't see your question?
Admissions answers calls 9 a.m.–5 p.m., seven days a week. Calls are confidential.
Call(760) 388-6369Visits, phones, what to bring and more in the admissions FAQ →All the ways to reach Wings →What happens while my plan reviews the request?
Admissions keeps you updated and explains your options in the meantime, including timing and what you may owe.
When does a single case agreement make sense?
When your plan has no in-network residential, PHP or IOP program for what you need, in-network programs cannot take you in time, or your HMO or EPO plan has no out-of-network benefits.
Who asks for the agreement?
Admissions does. They contact your plan’s case manager with the clinical information your plan needs. You do not have to negotiate it yourself.
How long does it take?
It depends on your plan. Admissions keeps you updated and tells you as soon as there is an answer. If you are leaving a hospital, call early.
Is a single case agreement guaranteed?
Your plan decides. If it says no, admissions can explain other options, such as out-of-network benefits or private pay.
What will I pay with a single case agreement?
It depends on the agreement. Many use your in-network cost share. Admissions explains the terms before you start.