Bill
H 3302
The bill protects insured patients from surprise bills by out-of-network providers in emergencies or at in-network facilities, by ensuring cost-sharing parity and requiring insurer
Status snapshot
- Bill number: H 3302 (titled "Stop Surprise Bills")
- Classification: bill
- Key procedural dates: Prefiled 12/05/2024; Introduced 01/14/2025; Referred to committee(s) (Labor, Commerce & Industry; State Admin. & Regulatory Oversight); Senate concurred 02/27/2025; Hearing(s) scheduled 10/14/2025. (Record shows duplicate entries and related docket HD 1284.)
Note on inconsistent text in the file
- The legislative text provided with the docket contains two different measures: a South Carolina "Stop Surprise Bills Act" (full text concerning surprise medical billing) and, separately, a Massachusetts bill (House No. 3302) to establish a state children's cabinet. This summary focuses on the "Stop Surprise Bills" provisions (surprise medical billing), which appear in the South Carolina draft contained in the record.
Purpose and intent
- To protect insured patients from unexpected ("surprise") medical bills when they receive care from out‑of‑network providers in emergency situations or at in‑network facilities without knowingly electing out‑of‑network care. The bill seeks to limit patient cost exposure, regulate insurer and provider billing practices, and classify surprise billing as an unfair trade practice.
Key definitions
- "Surprise bill": a bill for services (including lab tests) from an out‑of‑network provider rendered at an in‑network facility, during a procedure performed by an in‑network provider, for a previously authorized service, or emergency services — provided the insured did not knowingly elect out‑of‑network care. Excludes cases where an in‑network provider was available and the insured knowingly chose out‑of‑network care.
Major provisions
- Patient cost-sharing parity for emergency care: Insurers may not impose a coinsurance, copayment, deductible, or other out‑of‑pocket expense for emergency services (including labs) rendered by an out‑of‑network provider that is greater than the amount that would apply if those services were rendered in‑network.
- Provider reimbursement for emergency services: For emergency care from out‑of‑network providers, the insurer must reimburse the provider the greatest of: (a) the amount the plan would pay an in‑network provider for the same service; (b) the usual, customary, and reasonable (UCR) rate; or (c) the Medicare reimbursement amount. Insurer and provider may agree to a higher amount.
- Billing and payment for surprise bills more broadly: An insured may only be required to pay the in‑network cost‑sharing that would apply; insurers must reimburse the out‑of‑network provider or insured at the in‑network rate as payment in full, unless the insurer and provider agree otherwise.
- No prior authorization for emergency services: Insurers may not require prior authorization for emergency services (including labs).
- Unfair trade practice: Surprise billing by insurers or providers is defined as an unfair trade practice under the State’s consumer protection statutes.
- Department of Insurance (DOI) reporting: Within one year of the bill’s effective date, the DOI must report to the Governor and Legislature on the effectiveness of dispute‑resolution practices between providers and insurers and provide recommendations; the DOI must post the report online.
Who is affected
- Insured patients: reduced risk of unexpected high bills for emergency or involuntary out‑of‑network care.
- Out‑of‑network providers and laboratories: limits on balance billing and potentially modified reimbursement rules.
- Insurers: new payment and payment parity requirements; administrative obligations (e.g., no prior auth for emergencies).
- State agencies: DOI tasked with evaluating dispute resolution and monitoring compliance; consumer protection enforcement for unfair trade practice claims.
Implementation and timeline
- Effectiveness: the bill takes effect upon gubernatorial approval (per the SC draft). DOI must submit its dispute‑resolution efficacy report within one year of the effective date.
- Legislative process: hearings scheduled (10/14/2025 per docket); committee referrals and concurrence steps recorded.
Potential impacts and considerations
- Patient financial protection will likely increase for emergency and involuntary out‑of‑network care.
- The reimbursement rules (especially requiring insurers to pay the greatest of in‑network amount, UCR, or Medicare for emergency services) may affect insurer costs and provider negotiation dynamics.
- The bill does not establish a detailed independent dispute resolution (IDR) mechanism in the text provided; DOI review is required to recommend best practices and possible changes.
- Providers, insurers, and policymakers may need to resolve operational details (notifications, claim processing, and enforcement) during implementation.
If you want, I can:
- Produce a side‑by‑side comparison of the bill’s payment rules for emergency vs. non‑emergency surprise bills, or
- Draft a short explainer for patients on their consumer protections under this bill.
Compiled from official sources — confirm details with the bill’s official record.
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