Blue Cross and Blue Shield of South Carolina claim denials in South Carolina: the federal figures
Blue Cross and Blue Shield of South Carolina denied 21.6% of in-network claims in South Carolina — 2,127,428 claims out of 9,840,399. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Blue Cross and Blue Shield of South Carolina) | 3,055 | 35.4% |
| External review (independent) | 67 | 19.4% |
What Blue Cross and Blue Shield of South Carolina denies most
The most common denial reason recorded for Blue Cross and Blue Shield of South Carolina plans in South Carolina is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 1,269,906 | 37.8% |
| Administrative reason | 818,507 | 24.4% |
| Benefit limit reached | 388,833 | 11.6% |
| Member not covered | 232,338 | 6.9% |
| Not medically necessary | 207,047 | 6.2% |
| Provider out of network | 162,011 | 4.8% |
| Service excluded from the plan | 140,756 | 4.2% |
| Referral required | 136,940 | 4.1% |
| Experimental or investigational | 4,123 | 0.1% |
What to do if Blue Cross and Blue Shield of South Carolina denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Blue Cross and Blue Shield of South Carolina overturned 35.4% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Blue Cross and Blue Shield of South Carolina. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Blue Cross and Blue Shield of South Carolina appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Blue Cross and Blue Shield of South Carolina's denial rate high?
21.6% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Blue Cross and Blue Shield of South Carolina ignore the external decision?
No. External review decisions are binding on the plan.