Resources · Out of network

What Is a SingleCase Agreement?

A single case agreement lets your health plan pay an out-of-network clinic for one person's care, on terms written for that case.

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  • ContractOne case only
  • Who decidesYour health plan
  • Who asksThe provider

The short version

A Single Case Agreement Covers One Person

A single case agreement is a contract between your health plan and an out-of-network provider for one member's care. A plan may agree to one when its network has no program that can give the care you need nearby or soon enough. If Exist is out of network on your plan, we can talk with your plan about one after we check your benefits.

Your health plan makes the decision, and approval is never guaranteed.

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Two people walking down a quiet palm-lined street toward the ocean at dusk, backs to camera, one pulling a small suitcase, a huge pale sun at the end of the street.

How a Single Case Agreement Request Moves

Each plan runs its own review, with no standard form or timeline. Here is the general order, starting with the free benefits check we do for you.

  1. A phone lying face down on a dark walnut side table beside a tall window at dusk, a small ceramic cup and a cream plaster wall.

    The Check

    We check your benefits for free and learn whether Exist is in network on your plan, and we get back to you within one business day.

  2. A person standing at a tall window in a cream plaster room at dusk, back to camera, a phone held at their side, a pale sun over the ocean and a sandstone headland.

    The Request

    If Exist is out of network for you, we can talk with your plan about covering PHP or IOP here through a single case agreement.

  3. A narrow dirt trail climbing a dark coastal ridge above the Pacific at dusk, one small figure on the path with back to camera, a pale sun above the ridge.

    The Review

    The plan reviews the request on its own timeline. It can say yes, say no, or ask for more clinical information before it decides.

  4. Two people sitting on the front steps of a cream stucco house at dusk, backs to camera, looking down a hillside street toward the ocean and a huge pale sun.

    The Answer

    We tell you what the plan decided and what the agreement covers. Then you choose whether to start, wait, or pay another way, like a payment plan or CareCredit.

Reasons a Plan May Say Yes

Plans decide case by case, and none of these reasons guarantees an agreement. They are the situations where a request is worth making.

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  1. No Program Nearby

    The plan has no in-network program at the level of care you need within a reasonable distance of where you will stay.

  2. No Opening in Time

    In-network programs exist, but none can see you within the wait times your plan or state law allows.

  3. Specialized Care

    Your network has no program that treats trauma, BPD, and substance use together, with DBT as part of the care.

  4. State Rules Apply

    In California, state-regulated health plans must arrange out-of-network mental health care at in-network cost sharing when their network cannot provide it in time.

    • California plans

What Changes Under an Agreement

The contract

In network

A standing contract between the clinic and your plan.

Single case agreement

A one-time contract for one member's care.

What it covers

In network

Covered services under your plan's benefits.

Single case agreement

The services, rate, and dates the agreement names.

Your cost

In network

Your in-network deductible, copay, and coinsurance.

Single case agreement

Set by the agreement, so ask whether in-network cost sharing applies.

Who decides

In network

Your plan's usual rules, including any prior authorization.

Single case agreement

Your plan, case by case, with no promise of approval.

Questions About Single Case Agreements

It is a contract between a health plan and an out-of-network provider for one member's treatment. It sets which services the plan will pay for, at what rate, and for how long.

Something we didn’t cover? Call (949) 670-9345 or text us.

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Ask Whether an Agreement Is Possible

Call or text us at (949) 670-9345. We'll check your benefits for free first, then talk with you about whether a single case agreement is worth asking your plan for. Benefits vary by plan.

Clinically reviewed by Dr. Courtney Tracy, LCSW, PsyD · Reviewed September 2026

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