Bill
H 3089
Requires providers to file personal-injury claims with the patient's insurer within 30 days of treatment, or forfeit the right to reimbursement.
Status snapshot
- Bill number: H 3089
- Subject: Medical billing / provider claims filing requirement
- Jurisdiction: South Carolina (adds S.C. Code § 44-7-395)
- Introduced / prefiled: 12/05/2024 (prefile); legislative activity through 05/01/2025; hearing scheduled 10/28/2025.
- Current stage (per provided record): Passed House (4/30/2025, Yeas 107 / Nays 9), sent to Senate 05/01/2025, referred to Senate Committee on Medical Affairs; committee hearing set for 10/28/2025.
- Effective date: On approval by the Governor.
Purpose and intent
- Require hospitals and other medical providers who treat an insured person for a personal injury to timely submit a claim to the patient’s health insurer for reimbursement — with failure to do so resulting in forfeiture of the provider’s right to reimbursement. The bill aims to shift initial billing responsibility to providers and to ensure insurers are promptly notified and billed.
Key provisions
- New statutory section: S.C. Code § 44-7-395.
- Filing requirement: Providers that have provided treatment or another service to an insured patient for a personal injury must file (or “initiate the claim’s process” in the amended language) with the patient’s primary health insurer within 30 days of providing the treatment or service.
- Consequence for noncompliance: Failure to submit the claim within 30 days “constitutes a forfeiture of the provider’s right to reimbursement.”
- Carve-out (amendment): Does not prevent a provider from seeking reimbursement from Medicare or Medicaid “as permissible by law.”
Who would be affected
- Directly affected: Hospitals, health care facilities, and other medical providers delivering treatment for personal injuries to insured patients in South Carolina.
- Indirectly affected: Health insurers (receiving earlier claims), patients (potential consequences for balances or collections), and public payers (Medicare/Medicaid addressed by a limited carve-out).
- Other stakeholders: Emergency departments, trauma centers, personal-injury legal practices, and billing/administrative services that manage claims.
Potential impacts and considerations
- Operational: Providers would need to ensure claims are submitted within a 30-day window — likely requiring changes to intake, billing workflows, and tracking systems to avoid forfeiture risk.
- Financial: Noncompliant providers could lose contractual or statutory rights to be reimbursed for care provided for personal-injury claims; depending on enforcement and patient protections, costs might be absorbed by providers or shift to patients.
- Legal/administrative ambiguities:
- The bill does not define key terms such as “file a claim,” “initiate the claim’s process,” “insured patient,” or “health insurer.” The practical meaning (electronic submission, timely filing vs. completed adjudication) may require rules or litigation.
- Interaction with ERISA-governed health plans, provider-insurer contracts, subrogation, liens, workers’ compensation, and federal law (Medicare/Medicaid) may raise preemption and compliance questions.
- Enforcement: The statute creates a forfeiture remedy but does not specify enforcement mechanisms, notice requirements, exceptions (e.g., delayed eligibility info), or dispute resolution processes.
Procedural timeline (selected entries from record)
- 12/05/2024 — Prefiled
- 01/14/2025 — Introduced; referred to Committee on Medical, Military, Public and Municipal Affairs
- 04/29/2025 — Committee report favorable
- 04/30/2025 — Amended; Read second time; Passed House (Yeas 107 / Nays 9)
- 05/01/2025 — Read third time and sent to Senate; referred to Committee on Medical Affairs
- 10/28/2025 — Committee hearing scheduled (B-2, 1:00–5:00 PM)
Note on source material
- Provided materials also included text from an unrelated Massachusetts bill (House Docket No. 1130) on taxation of digital advertising services; that text is not part of H 3089 (South Carolina medical billing) and appears to be included in error.
If you want, I can:
- Draft potential clarifying amendments (definitions, exceptions, enforcement procedure), or
- Prepare a short memo on interactions with ERISA/Medicare/Medicaid and likely legal issues.
Compiled from official sources — confirm details with the bill’s official record.
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