Who should I call if I have any questions about filing a complaint?

You can contact the Department at (803) 737-6180 or (800) 768-3467. The Department is open from 8:00 a.m. to 6:00 p.m. Monday through Thursday and 8:00 a.m. to 5:00 p.m. on Friday.

What happens after the Consumer Services Division receives my complaint?

Once the Division receives your complaint, it will forward a copy of your complaint to your health insurer for a response. Your insurer has ten days to respond. The Division will evaluate your case to determine whether your insurer violated...

How do I file a complaint?

If you are a South Carolina resident and your claim is denied after the external review process, you can file a complaint with the Consumer Services Division of the South Carolina Department of Insurance (“Division”). Complaint information. Your complaint should include...

How long will the external review process take?

The external review process should take no more than 45 days once the IRO receives your request and documentation from your insurer.[13] If you requested an expedited external review, the process should take no longer than three business days after your...

How do I request an external review?

Deadlines. You must submit a written request for a standard external review to your health insurer within 60 days from the date of the insurer’s final decision and within 15 days if you are requesting an expedited external review.[7] Your health insurer...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say whether to approve a treatment or pay a claim. In South Carolina, you can request a standard external review if...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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