Molina Healthcare of South Carolina denied your claim. Here is your deadline.
Put in the date on your MOLINA HEALTHCARE OF SOUTH CAROLINA, INC notice and get both federal deadlines as calendar dates.
Free, for an MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denial in South Carolina, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denied 230,150 of 1,055,016 in-network claims in South Carolina; every one of those denials had these same two dates on it. Across South Carolina as a whole the insurers in this file denied 17% of in-network claims, 3,656,371 of them, and 5,055 were appealed.
MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denied 21.8% of in-network claims in South Carolina, 230,150 claims out of 1,055,016.
Insurance got denied, what to do next?
Those 230,150 denials are 6.3% of every in-network denial recorded in South Carolina in this release, which makes MOLINA HEALTHCARE OF SOUTH CAROLINA, INC the 3rd largest source of denials of the 5 insurers reporting there. Spread across its 12 plans in the state that is about 19,179 denials per plan. 422 internal appeals were filed against those 230,150 denials. Every one of those denials carried the same two dates the tool at the top of this page works out.
Two dates matter more than anything else on this page, and they run the same in South Carolina as everywhere else. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
You are not alone, and here is the measured version of that sentence: 230,150 in-network claims were denied by MOLINA HEALTHCARE OF SOUTH CAROLINA, INC in South Carolina in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.
- Of the 5 insurers reporting a denial rate in South Carolina, MOLINA HEALTHCARE OF SOUTH CAROLINA, INC is the second highest at 21.8%. The highest in the state is 32.7% and the lowest is 15.5%.
- That is 3.1 percentage points above the 18.7% national average across this dataset, and 4.8 points above the South Carolina average of 17%.
- Behind the percentage: 1,055,016 in-network claims were processed under 12 plans in South Carolina, and 230,150 of them came back denied.
- For every 10,000 claims MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denied, about 18 came back as an internal appeal. The other 9,982 stopped at the letter.
- Of the internal appeals it did receive, MOLINA HEALTHCARE OF SOUTH CAROLINA, INC overturned 57.58%, 243 claims that started life as a no.
- Not one of those denials reached independent external review, the stage whose decision the plan is required by law to accept, and where nationally 32.8% are overturned.
- Its most-recorded denial reason is not medically necessary at 33.3% of its categorized denials, against 4.6% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- MOLINA HEALTHCARE OF SOUTH CAROLINA, INC accounts for 6.3% of every in-network claim denied in South Carolina in this file.
- By raw volume it is the 65th largest source of denials among the 158 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is administrative reason, 125,386 claims, 23.5% of its categorized denials.
- Third on its own list is benefit limit reached, 62,817 claims, 11.8% of what MOLINA HEALTHCARE OF SOUTH CAROLINA, INC categorized in South Carolina. Between them the top three account for 68.6% of its categorized denials.
- Where MOLINA HEALTHCARE OF SOUTH CAROLINA, INC differs most from the national mix is not medically necessary: 33.3% of its categorized denials in South Carolina against 4.6% across the file.
- Read the other way round: 824,866 of those 1,055,016 in-network claims were paid, 78.2% of everything MOLINA HEALTHCARE OF SOUTH CAROLINA, INC processed in South Carolina.
- Spread across the 12 plans it reports in South Carolina, that is about 19,179 denied claims per plan, on about 87,918 claims processed per plan.
- Its reason columns add up to 533,425 categorized rows against 230,150 denials, 231.8% of them, and every reason share on this page is a share of that first figure rather than of the second.
- Its smallest recorded category in South Carolina is experimental or investigational, 5,734 claims, 1.1% of what MOLINA HEALTHCARE OF SOUTH CAROLINA, INC categorized there.
- Against the file as a whole, this one record is 0.3% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason MOLINA HEALTHCARE OF SOUTH CAROLINA, INC records most often in South Carolina is not medically necessary, but yours may be one of the other 8, copy the exact wording and code off your own letter tonight, because that sentence is what your appeal has to answer.
- Ask MOLINA HEALTHCARE OF SOUTH CAROLINA, INC in South Carolina for the clinical criteria they judged you against. Under 29 CFR 2560.503-1 they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.
- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. MOLINA HEALTHCARE OF SOUTH CAROLINA, INC overturned 57.58% of the internal appeals it did receive, 243 claims, so the stage you are about to start is not decorative.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| MOLINA HEALTHCARE OF SOUTH CAROLINA, INC | 21.8% | , |
| South Carolina average | 17% | +4.8 pts |
| National average (this dataset) | 18.7% | +3.1 pts |
MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denies 3.1 percentage points more of its in-network claims than the national average across this dataset. A denial rate is a property of the insurer's book of business, coding practice, plan design, the population it covers, not evidence about the merits of any one claim, including yours.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to MOLINA HEALTHCARE OF SOUTH CAROLINA, INC) | 422 | 57.58% |
| External review (independent) | 0 | 0% |
The gap nobody escalated
230,150 claims denied. 422 internal appeals filed. None reached independent external review. Nationally 32.8% of external reviews are overturned and the decision binds the plan.
That is arithmetic from the reported figures, not a prediction: nobody can say what those specific denials would have done at review, because they never got there. What the numbers do establish is that the binding stage was almost entirely unused here.
What that record means for your own MOLINA HEALTHCARE OF SOUTH CAROLINA, INC letter, and by when. MOLINA HEALTHCARE OF SOUTH CAROLINA, INC overturned 57.58% of the 422 internal appeals its South Carolina members filed against 230,150 denials, and not one of those South Carolina denials went on to the independent stage whose decision binds the plan, MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 2026 (data.healthcare.gov). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal (29 CFR 2560.503-1(h)(3)(i), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your MOLINA HEALTHCARE OF SOUTH CAROLINA, INC notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for MOLINA HEALTHCARE OF SOUTH CAROLINA, INC in South Carolina. One payment. No subscription. No cut of your claim.
MOLINA HEALTHCARE OF SOUTH CAROLINA, INC inside South Carolina
Your denial did not happen in a national average. It happened in a state market, alongside 5 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of South Carolina, the 6 insurers reporting in this file processed 21,454,469 in-network claims and denied 3,656,371 of them, a state denial rate of 17%. MOLINA HEALTHCARE OF SOUTH CAROLINA, INC is one of those 6.
- That puts South Carolina 21th of 30 states by denial rate, 1.7 points below the 18.7% national average, before you get to what MOLINA HEALTHCARE OF SOUTH CAROLINA, INC did inside it.
- South Carolina recorded 5,055 internal appeals against those denials: one appeal for every 723 claims the state's insurers refused. MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's own ratio is one for every 545.
- Independent external review was reached 234 times in the whole of South Carolina, once for every 15,626 denials, against one in 14,369 nationally. None of them came from MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's denials.
- Of the South Carolina external reviews that were filed, 132 were overturned, 56.4%. That percentage is measured on 234 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.
- The reason South Carolina's insurers record most often is other reasons, 992,225 claims, 24.5% of the state's categorized denials. MOLINA HEALTHCARE OF SOUTH CAROLINA, INC records not medically necessary most often instead, which is the argument your letter will need to answer.
- The other insurers a South Carolina reader could have bought from run from 32.7% (Select Health of South Carolina) to 15.5% (Blue Cross and Blue Shield of South Carolina). MOLINA HEALTHCARE OF SOUTH CAROLINA, INC at 21.8% sits between the two.
- Put the two together and MOLINA HEALTHCARE OF SOUTH CAROLINA, INC is responsible for 6.3% of every in-network claim denied in South Carolina in this release, from 4.9% of the claims the state's insurers processed.
- Every South Carolina figure in this section is that state's own row in the same federal file MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full South Carolina page is free at /states/south-carolina.
What MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denies most
The most common denial reason recorded for MOLINA HEALTHCARE OF SOUTH CAROLINA, INC plans in South Carolina is not medically necessary. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Not medically necessary | 177,868 | 33.3% | 4.6% |
| Administrative reason | 125,386 | 23.5% | 22.5% |
| Benefit limit reached | 62,817 | 11.8% | 4.2% |
| Referral required | 62,720 | 11.8% | 8.4% |
| Member not covered | 46,828 | 8.8% | 6.6% |
| Other reasons | 24,467 | 4.6% | 32.3% |
| Provider out of network | 20,335 | 3.8% | 9.8% |
| Service excluded from the plan | 7,270 | 1.4% | 11.6% |
| Experimental or investigational | 5,734 | 1.1% | 0.1% |
The last column is each reason's share of all categorized denials nationally, so you can see where MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's mix in South Carolina differs from everyone else's. This is denial mix, not overturn rate by reason, the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.
Put the date from your notice in and get the two calendar dates, with the days remaining.
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The three steps at the top of this page are the whole of what you have to do tonight. The longer version, what the internal appeal has to contain, how the independent stage works, and how to ask for expedited handling when waiting would seriously jeopardize your health, is published free here. For what it is worth on this page specifically: MOLINA HEALTHCARE OF SOUTH CAROLINA, INC overturned 57.58% of the internal appeals it received.
Who appeals what at Molina Healthcare, the insurer's own routing table
Molina Healthcare publishes a table of which denial scenarios are appealed by you, the member ("customer appeal") and which only your health care provider can appeal. Almost no patient ever sees it, and appealing a denial that only your provider has standing to appeal burns time inside a fixed window. Quoted from Molina Healthcare's published policy (a page written for members (Iowa Medicaid plan)), checked 2026-08-25. It is brand-level and applies to MOLINA HEALTHCARE OF SOUTH CAROLINA, INC in South Carolina the same as to every other Molina Healthcare entity in the file.
| Denial scenario (Molina Healthcare's wording) | Who appeals it |
|---|---|
| Appeal of a denial (this Medicaid plan) | Your provider |
| Unhappy with Molina's appeal decision | Your provider |
Operational facts from the same policy
- Appeal filing window (this plan): 60 calendar days
- Decision clock: 30 calendar days standard, expedited available
- State Fair Hearing window: 120 calendar days
Source: Molina Healthcare, "Member Appeals & Grievances (Molina Healthcare of Iowa, Medicaid — hosted by Iowa HHS)", quoted, not paraphrased; audience: members (Iowa Medicaid plan); checked 2026-08-25. Brand-level policy, applied here because MOLINA HEALTHCARE OF SOUTH CAROLINA, INC is a Molina Healthcare entity. Your own denial letter and plan documents govern your specific case.
Questions
Is MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's denial rate in South Carolina high?
21.8% against a national average of 18.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed an MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denial in South Carolina, and how many won?
422 internal appeals were filed against 230,150 denials, and 57.58% of them were overturned (243 claims). Not one went on to independent external review, the stage whose decision is binding on the plan.
How does MOLINA HEALTHCARE OF SOUTH CAROLINA, INC compare with other insurers in South Carolina?
Of the 5 insurers in South Carolina with a reported denial rate, MOLINA HEALTHCARE OF SOUTH CAROLINA, INC ranks 2 highest at 21.8%. The highest in South Carolina is Select Health of South Carolina at 32.7%; the lowest is Blue Cross and Blue Shield of South Carolina at 15.5%.
What does MOLINA HEALTHCARE OF SOUTH CAROLINA, INC deny most often in South Carolina?
Not medically necessary, 177,868 claims, 33.3% of this issuer's categorized denials, against 4.6% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal an MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denial in South Carolina?
Generally 180 days from the date on the denial notice to file the internal appeal, then generally four months from the final internal denial to request independent external review. Expedited review, decided in about 72 hours, is available where delay would seriously jeopardize your health. Those timeframes are federal, so they are identical for every insurer reporting in South Carolina, MOLINA HEALTHCARE OF SOUTH CAROLINA, INC included, what varies by state is who runs the independent review at the end. Your own denial letter states the deadlines that govern your plan; that letter is the authority.
Does appealing an MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denial in South Carolina cost anything?
The internal appeal to MOLINA HEALTHCARE OF SOUTH CAROLINA, INC 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 per review. Nobody in South Carolina can be charged more than that to file one.
Can MOLINA HEALTHCARE OF SOUTH CAROLINA, INC ignore an external review decision in South Carolina?
No, and that is the whole point of the stage. External review decisions are binding on the plan by law, which is what makes the zero external reviews recorded against 230,150 MOLINA HEALTHCARE OF SOUTH CAROLINA, INC denials in South Carolina the striking number on this page.
The line on this page I would read twice is the one that says not one of MOLINA HEALTHCARE OF SOUTH CAROLINA, INC's 230,150 denials in South Carolina reached independent review. I am not going to tell you that you will win. This page prints the insurer's own reported numbers whichever way they fall. If what it says does not match the letter in your hand, write to me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your MOLINA HEALTHCARE OF SOUTH CAROLINA, INC appeal in South Carolina: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
The MOLINA HEALTHCARE OF SOUTH CAROLINA, INC figures on this page, the 21.8% denial rate, the 230,150 denials and the 0 external reviews, are this issuer’s own reported rows in that file.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).