How can I help Swing Care get in-network coverage with my insurance provider?

  • Updated

If Swing Care is out-of-network with your insurance plan, it means we are not part of the group of providers that your insurance company has an agreement with. If your plan has no out-of-network benefits, you may choose to initiate process called a Letter of Agreement (LOA) or a Single Case Agreement (SCA).

 

What is an LOA or SCA?

  • LOA: A Letter of Agreement is a contract between an insurance company and an out-of-network provider (e.g. Swing Care). It allows the provider to offer services to patients who have that specific insurance.
  • SCA: A Single Case Agreement is also a contract between an insurance company and an out-of-network provider (e.g. Swing Care). It is used when a patient needs a specialized service that is not available from an in-network provider within a reasonable amount of time or proximity.

If your insurance team is unable to find a suitable doctor within your network, you can request that they explore the possibility of obtaining an LOA or SCA:

  • Emphasize that you are paying for a premium insurance plan, so you expect to be able to access the care you need.
  • Clearly explain why the in-network providers they are suggesting do not meet your needs, based on your specific medical situation and diagnosis.
  • Provide information about the out-of-network provider you would like to see, and the reasons they would be more appropriate to provide the care you require.
  • Request that they provide an out-of-network authorization (LOA or SCA) so you can see the provider you prefer without incurring higher out-of-pocket costs.
  • Be clear, firm, and focus on your specific medical needs and the limitations of the in-network options they've presented.

Please keep in mind that for the treatment of fibromyalgia, insurance plans may have several options for the patient to try first, such as specialists with Pain Medicine or Rheumatology expertise. It will be the patient's responsibility to work with their health plan to determine if these options are not suitable.

 

Initiating the Process:

To initiate the process of obtaining an LOA or SCA, you will need to call your insurance company's member services to discuss why existing providers in their network may not meet your needs. That may include:

  • if there are no providers in your area
  • if there are no available appointments in a reasonable amount of time
  • if the services are not similar/equivalent

You can find the phone number for member services on your insurance card. When you speak to a representative, ask to be transferred to the authorization department. Explain that you would like to start a LOA or SCA because your preferred healthcare provider is out-of-network.

 

Important Information to Gather:

During the call, make sure to note down the following information:

  • The phone number you called for member services.
  • The name of the representative you spoke to (first name and first initial of the last name).
  • If provided, write down any reference number or authorization number given to you during the call.

If the out-of-network authorization (LOA or SCA) is approved, your health plan will notify you that Swing Care can provide services and submit the bill to the insurance company as if we were in their network.

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