H 3302

South Carolina General Assembly
126th Session, 2025-2026
Bill 3302
Indicates Matter Stricken
Indicates New Matter
(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)
A bill
TO AMEND THE SOUTH CAROLINA CODE OF LAWS by ENACTing THE
"STOP SURPRISE BILLS ACT" BY ADDING SECTION 38-71-292 SO AS TO PROHIBIT
INSURERS AND HEALTHCARE PROVIDERS FROM ENGAGING IN SURPRISE BILLING; AND BY
ADDING SECTION 39-5-45 SO AS TO MAKE IT AN UNFAIR TRADE PRACTICE FOR AN INSURER
OR HEALTHCARE PROVIDER TO ENGAGE IN THE PRACTICE OF SURPRISE BILLING.
Whereas,
it is the goal of the State of South Carolina to protect patients from
"surprise bills" from medical providers; and
Whereas, surprise billing
occurs when a patient unknowingly receives medical care from an out-of-network
healthcare provider, either because of emergency treatment or because an
out-of-network healthcare provider participated in or provided routine,
scheduled care without the patient affirmatively choosing the receive out-of-network
care; and
Whereas, it is against
public policy for South Carolina citizens to receive exorbitant and unexpected
medical bills, which frequently arrive even before the patient has recovered
from the unplanned, emergency health crisis. Now therefore,
Be it enacted by the General Assembly of the State of
South Carolina:
SECTION 1.  This act may be cited as the "Stop Surprise Bills Act."
SECTION 2.  Article 1, Chapter 71, Title 38 of the S.C. Code is
amended by adding:
    Section
38-71-292.     (A) "Surprise bill" means a bill for
healthcare services, including laboratory services and tests, received by an
insured for services rendered by an out-of-network healthcare provider at an
in-network facility, during a service or procedure performed by an in-network
provider or during a service or procedure previously approved or authorized by
the insurer and the insured did not knowingly elect to obtain services from an
out-of-network provider. It also includes emergency services rendered at an out
of network healthcare provider. "Surprise bill" does not include a bill for
healthcare services received by an insured when an in-network healthcare
provider is available to render such services and the insured knowingly elects
to obtain services from an out-of-network healthcare provider.
    (B)
No health insurer may impose a coinsurance, copayment, deductible, or other
out-of-pocket expense for emergency services, including laboratory tests and
services, rendered by an out-of-network healthcare provider that is greater
than the coinsurance, copayment, deductible or other out-of-pocket expense that
would be imposed if such emergency services were rendered by an in-network
healthcare provider.
    (C)(1) If an insured receives emergency
services, including laboratory tests and services, from an out-of-network
healthcare provider, such healthcare provider may bill the insurer directly and
the insurer must reimburse the healthcare provider the greatest of the
following amounts:
  (a)
the amount the insured's healthcare plan would pay for the same services if
rendered by an in-network healthcare provider;
  (b)
the usual, customary, and reasonable rate for the same services; or
  (c)
the amount Medicare would reimburse for the same services.
       (2)
Nothing in this subsection prohibits an insurer and out-of-network healthcare
provider from agreeing to a greater reimbursement amount.
    (D)
An insurer may not require prior authorization for the rendering of emergency
services, including laboratory tests and services to an insured.
    (E)   With
respect to a surprise bill:
       (1)   an
insured only may be required to pay the applicable coinsurance, copayment,
deductible, or other out-of-pocket expense that would be imposed for such
healthcare services if such services were rendered by an in-network healthcare
provider; and
       (2)
an insurer must reimburse the out-of-network healthcare provider or insured, as
applicable, for healthcare services rendered at the in-network rate under the
insured's healthcare plan as payment in full, unless the insurer and healthcare
provider agree otherwise.
    (F)
It is an unfair trade practice in violation of Chapter 5, Title 39 for any
healthcare provider, including a laboratory, to request from an insured payment
other than the applicable coinsurance, copayment, deductible, or other out-of-pocket
expenses that would be imposed for such healthcare services if the services
were rendered by an in-network provider for:
       (1)
emergency services covered under a healthcare plan and rendered by an out-of-network
healthcare provider; or
       (2)
surprise bill, as defined in subsection (A).
    (G)  Within
one year following the effective date of this section, the Department of
Insurance must report to the Governor and the General Assembly on the efficacy
of dispute resolution practices between providers, including physicians,
laboratories, and hospitals and insurers and make recommendations for any
changes that should be made based on best practices from surprise billing laws
in other states. The Department of Insurance also shall post this information
on its agency website.
SECTION 3.  Article 1, Chapter 5, Title 39 of the S.C. Code is
amended by adding:
    Section
39-5-45. It is an unfair trade practice pursuant to Section 39-5-20 for a
healthcare insurer or provider to engage in "surprise billing" as defined in
Section 38-71-292(A).
SECTION 4.  This act takes effect upon approval
by the Governor.
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This web page was last updated on December 06, 2024 at 11:17 AM