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H 3539

Uninsured Patient Fees

2025-2026 Regular Session Introduced by Robert Williams

Hospitals may not charge uninsured patients more than the maximum fee charged to insured patients for the same services.

Referred to Committee on Medical, Military, Public and Municipal Affairs
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Bill Summary · H 3539

Summary — H 3539: Uninsured Patient Fees

Note: The bill file provided contains text from multiple pieces of legislation. This summary focuses on the Uninsured Patient Fees provision that would be added to South Carolina law (Section 44‑7‑55), as that language is the subject identified in the prompt.

Purpose

To prohibit hospitals from charging uninsured patients fees for medical services that exceed the maximum fees charged to insured patients for the same services. The intent is to limit higher out‑of‑pocket charges or billed amounts imposed on uninsured individuals compared with insured patients receiving identical hospital services.

Key provision

  • Adds Section 44‑7‑55 to Article 1, Chapter 7, Title 44 of the South Carolina Code of Laws.
  • Text (summary): “A hospital licensed in this State may not charge uninsured patients fees for services rendered that are in excess of the maximum fees charged for the same services rendered to insured patients.”
  • Effective date: the act takes effect upon approval by the Governor.

Who is affected

  • Primary: Hospitals licensed in South Carolina — they must adjust billing practices to ensure uninsured patients are not charged more than the maximum fee charged to insured patients for the same service.
  • Patients: Uninsured individuals would be protected from being billed amounts higher than insured patients’ maximum fees for identical services. Insured patients may be indirectly affected if hospitals change billing or discount policies.
  • Payers/Insurers: The bill compares uninsured charges to the “maximum fees charged to insured patients,” implicating insurer‑hospital negotiated rates or hospital charge masters; how those maximums are determined could affect insurer reimbursements or negotiated rate structures.
  • State regulators and courts: Responsible for enforcing the new statutory prohibition if disputes arise (the bill text does not itself create an enforcement mechanism).

Potential impacts and implications

  • Consumer protection: Likely to reduce price discrimination against uninsured patients and lower some hospital bills for the uninsured.
  • Hospital billing practices: Hospitals may need to revise charge masters, billing systems, charity care policies, and internal controls to ensure compliance.
  • Revenue effects: Potential downward pressure on gross charges billed to uninsured patients; fiscal impact on hospitals will depend on how frequently uninsured patients were previously billed above insured maximums.
  • Implementation issues: The bill does not define how to determine the “maximum fees charged to insured patients” (e.g., insurer negotiated rates, billed charge caps, or allowed amounts), nor does it specify penalties, an administrative enforcement mechanism, or dispute resolution procedures. Those gaps may require follow‑on regulation, guidance, or litigation to operationalize the statute.
  • Interactions with existing policies: May affect hospital discounts, prompt‑pay policies, charity care programs, and agreements with insurers.

Procedural / timeline details (as provided)

  • Prefiled: 12/05/2024
  • Introduced and read first time: 01/14/2025
  • Referred to Committee on Medical, Military, Public and Municipal Affairs: 01/14/2025 (and again listed 12/05/2024 referral)
  • Senate concurred: 02/27/2025 (per provided actions)
  • Hearing scheduled: 10/29/2025, 1:00 PM–5:00 PM in A‑1
  • Effective upon the Governor’s approval (if enacted)

Open questions / considerations

  • How will “maximum fees charged to insured patients” be defined and measured?
  • What enforcement mechanisms, penalties, or administrative remedies will be used for violations?
  • How will the rule interact with federal law (e.g., surprise billing/EMTALA) and existing state consumer protection or hospital charity care statutes?
  • Would hospitals shift billing structures or insurer negotiations in response?

Related legislation

  • Document notes a related/replacing bill: HD 3405.

If you want, I can draft suggested definitions and an enforcement/penalty framework that would clarify implementation (e.g., defining “maximum fee” as the highest allowed amount paid by any insurer, establishing a civil penalty structure, and assigning enforcement to a state agency).

Compiled from official sources — confirm details with the bill’s official record.

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