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.
Located in Laguna Beach, California
(949) 670-9345- ContractOne case only
- Who decidesYour health plan
- Who asksExist admissions
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. Exist admissions can ask your plan for one after the benefits check. Your plan decides, and approval is never guaranteed.
Your plan decides. Admissions makes the request and tells you the answer.
How Exist asks
How a single case agreement request moves.
There is no standard form or clock for this, and each plan runs its own review. At Exist the request follows the benefits check, and it moves through these four steps.
The check
We call your plan with your member ID and date of birth and learn whether Exist is in network for you. That answer comes back within one business day.
The request
If Exist is out of network for you, admissions asks the plan whether it will cover PHP or IOP here through a single case agreement.
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.
The answer
We tell you what the plan decided and what the agreement covers. Then you choose whether to start, wait, or use another way to pay.
When a plan may agree
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.
Talk to admissionsNo 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.
No opening in time
In-network programs exist, but none can see you within the wait times your plan or state law allows.
Specialized care
Your network has no program that treats trauma, personality disorders, and substance use together, with DBT-informed skills in the same week.
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.
In network
The contract
A standing contract between the clinic and your plan.
A one-time contract for one member's care.
What it covers
Covered services under your plan's benefits.
The services, rate, and dates the agreement names.
Your cost
Your in-network deductible, copay, and coinsurance.
Set by the agreement, so ask whether in-network cost sharing applies.
Who decides
Your plan's usual rules, including any prior authorization.
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 — you talk to the clinic, not a call center.
Ask whether an agreement is possible.
Call Exist at (949) 670-9345. We check your benefits first, then tell you plainly whether a single case agreement request makes sense for your plan. Benefits vary by plan. Verification is not a guarantee of payment.
Clinically reviewed by Dr. Courtney Tracy, LCSW, PsyD · Reviewed September 2026