Written by a parent, not a doctor. Nothing here is medical advice.

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South Carolina program

Approval deadlines and keeping your child's doctor

South Carolina has rules about notice of a denial and keeping a doctor after a network change.

What it is

South Carolina has rules about notice of a denial and keeping a doctor after a network change.

Treatment can be disrupted while a plan reviews care or a doctor leaves the network. Different rules govern the decision, its notice and ongoing care. The plan’s coverage type and your child’s situation decide which protections fit.

Eligibility rules
  • The continuity right applies to qualifying clinical situations under individual, group and state health-plan coverage.
  • It includes the state employee and public-school plan, even though that plan is outside the state external-review act.
What you get
  • Continued care with a departing doctor for qualifying clinical situations.
  • Notice of an adverse decision within five business days for plans covered by the state notice rule.
What the help includes
  • Your social worker can help the plan confirm the continuation period for your child’s situation, including its start and end dates. The state continuity rule and federal continuing-care rule have separate conditions.
  • The deadline depends on the plan and the request. The hospital’s authorization staff can identify the controlling first-decision deadline, any step-therapy exception or gold-card rule, and the urgent-review route. A deadline to send a denial notice is not the same as a deadline to decide the request.
If you decide to apply
  1. Ask the plan for its written decision timeline and keep the date the clinic sent the request.
  2. For a network change, ask about continuity of care and the exact doctor and services it would cover.

The plan, with the insurance department behind the rules it does have · 800-768-3467 · Official page ↗

If you decide to go ahead
  • A written continuity decision can name the doctor, services and end date.
Good to know

Five business days is the notice deadline after a refusal. It is not a deadline to make the first decision.

Other details
  • If your child's doctor leaves the plan's network mid-treatment, ask the plan in writing how long your child can keep seeing them and which services are covered.
Official sources
Ask your social worker

“Could our child keep the same doctor after a network change, and what deadlines apply to a care request? Could you help us get the plan’s answer in writing?”

Why I’m asking: I want to understand which rules can prevent a treatment delay or a sudden doctor change.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask in writing, keep the dates, and escalate to the insurance department when a deadline passes.

Your social worker

The clinic's authorisation staff usually know the plan's own clock.

The care team

Records and letters when the application asks for them.

Who decides
The plan.
Ask the billing office
“What is your published turnaround for this authorisation, and if our oncologist leaves the network, how do we ask for continuity of care?”

How to apply

First step: Ask the plan in writing for its own published turnaround, and keep the date.

  1. Ask the plan in writing what its own turnaround is, and note the date you asked.
  2. If the oncologist's group leaves the network, ask for continuity of care by name the same week.

Official application / program page ↗

Where it starts: Ask the plan in writing for its own published turnaround and hold it to that. Ask for continuity of care by name when a doctor leaves the network.

What to gather

  • The request the clinic sent and the date
  • The plan booklet
  • Any letter about a network change

How long: Ninety days of continuity, or to the end of the benefit period if that is longer.

What a yes looks like

Written confirmation that your child can carry on with the same doctor.

What a no looks like, and the next move

Ask the insurance department's consumer line what applies to your plan, on 800-768-3467.

Watch out

  • Five business days is the deadline to be told of a refusal, not to make the decision.
  • The state employee and public-school plan is inside the continuity right even though it is outside the outside-review act.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Ninety days, or to the end of the benefit period, to keep a doctor who leaves the network. No state clock on a first authorisation decision was found.

  • $90 — Days you can keep a doctor who leaves the network
  • $5 — Business days to be told of a refusal
  • $2 — Business days the state employee plan gives itself for advanced imaging

Legal protection: Ninety days, or to the end of the benefit period, to carry on with a doctor who leaves the network, for the clinical situations the statute names · The continuity right includes the state employee and public-school plan

What it costs the family: Nothing.

The eligibility facts, as published

Continuity
90 days or the end of the benefit period, whichever is greater, for qualifying clinical situations; individual, group and the state health plan
Notification
five business days to notify an adverse decision, for entities the insurance department regulates
First decision clock
NOT FOUND
Gold card step therapy
NOT FOUND

The trap: The five business days in the state's review chapter is the deadline to notify an adverse decision, not a deadline to make the first decision. Nobody found a state clock for the first decision, so the plan's own published turnaround is what to hold them to.

Where I read this

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