State playbook

South Carolina

State insurers, legislation, and appeal resources for patients and advocates in South Carolina.

4 guides

Beginner guide for South Carolina—HealthCare.gov, SCDOI external review, Ch. 38-70 PA & Ch. 38-71 appeals.

Ch. 38-70—5-day adverse notice, preventive PA bans; pending S.B. 531 48/24-hour deadlines.

Ch. 38-71—180-day filing, 30/60-day decisions, deemed exhaustion, path to SCDOI IRO.

Binding on plan—60-day filing with carrier, 45-day IRO decision, 72-hour expedited.

Prior auth & internal appeals

Match the plan on the member ID card. Use the denial letter for where to file appeals.

BlueCross BlueShield of South Carolina
- Prior authorization
- Grievance & appeal
Ambetter / Absolute Total Care
- Prior authorization
- Grievance & appeal
Molina Healthcare of South Carolina
- Prior authorization
- Grievance & appeal
Select Health of South Carolina
- Prior authorization
- Grievance & appeal
UnitedHealthcare of South Carolina
- Prior authorization
- Grievance & appeal
HealthCare.gov (South Carolina Marketplace)
- Shop & enroll
- Find local help
South Carolina Medicaid
- Prior authorization
- Grievance & appeal

After internal appeal, for eligible South Carolina fully insured plans only.

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