External review in South Carolina: deadline, cost and how to ask
South Carolina runs its own independent review of denials: External review (Health Carrier External Review Act). You generally have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in South Carolina
- Program
External review (Health Carrier External Review Act)
- Who runs it
- Your health insurer, which must send the request to the South Carolina Department of Insurance; SCDOI assigns an independent review organization (IRO) on a rotating basis: Health insurance policies and HMO plans regulated by South Carolina (not self-funded ERISA plans)
- Deadline to ask
4 months
You must ask within four months of receiving the notice that your insurer denied your internal appeal. There is no deadline for an expedited external review. Grandfathered plans may still use the older state rule: 60 days for a standard review and 15 days for an expedited review.
- The deadline runs from
The date you receive the notice that the insurer has made an adverse determination under its internal appeal process
- Do I have to appeal to my plan first?
You normally must finish the insurer's internal appeal first. You can ask for an expedited external review while an expedited internal appeal is still going on. You are treated as having finished the internal appeal if the insurer does not follow the federal appeal rules or waives the internal appeal. For care already received, you must finish the internal appeal.
- How long the review takes
Standard: 45 days; Urgent: 72 hours
- Cost
The review costs you nothing. The insurer pays for the external review.
- What can be reviewed
Denials, reductions or terminations because a service does not meet the plan's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and denials of experimental or investigational treatment for a life-threatening or seriously disabling condition (your doctor must certify certain facts). You cannot get external review if your plan does not cover the service. For plans that are not grandfathered there is no minimum claim amount.
- Is the decision final?
The decision is binding on the insurer. If the reviewer reverses the denial, the insurer must approve the covered benefit. It is also binding on you except where you have other remedies under federal or state law. You cannot ask for a second review of the same denial.
- How to ask
Ask your health insurer in writing (at the address in your denial notice). Include a signed medical records release form and, for experimental or investigational denials, your doctor's certification. The insurer notifies the Department of Insurance, which assigns an IRO. You then have 5 business days after you receive the letter about the assignment to send more information to the IRO.
Law: S.C. Code 38-71-144
- Phone
Write my appeal: free letters
Sources
The official sources for South Carolina are listed on the South Carolina page.