South Carolina prompt pay law dental

Sourced answer

South Carolina's prompt-pay chapter (S.C. Code §38-59-230; §38-59-240 (rate via §34-31-20(A))) does not reach standalone dental insurance at all — Separately offered dental plans sit outside the article. Its "insurer" definition reaches an insurance company, a health maintenance organization, and any other entity providing "health insurance coverage, as defined in Section 38-71-670(6)" — and that definition excepts, when offered separately, "limited scope dental or vision benefits." Dental benefits embedded in a medical plan are inside the 20/40 business-day rule; a claim to a stand-alone dental carrier is not covered by it. The article also does not reach national account delivery program claims the insurer does not solely process, or state and federal government program claims other than as employer (§38-59-260). Where the chapter does apply (dental inside a comprehensive medical plan), the deadline is 20 business days (electronic) and 40 business days (paper). A self-funded private-employer (ERISA) dental plan is generally beyond a state prompt-pay statute's reach: 29 U.S.C. § 1144(b)(2)(B) bars a state from deeming such a plan an insurer, and the courts have read that to keep state insurance regulation off it. The statute itself never uses the words self-funded or prompt pay, and the rule is not categorical — a self-funded governmental or church plan is not an ERISA plan at all, so state law can reach it; § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law; and nothing in § 1144 addresses state enforcement against the third-party administrator or the network contract. Where the plan is a self-funded ERISA group health plan, the federal claims-procedure deadlines apply instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.