New S.C. Law Protects Choice Of Doctor For Seriously Ill
COLUMBIA, S.C. (AP) — South Carolinians with serious medical conditions get a new benefit Saturday with a health insurance law that bars insurers from charging them more for at least 90 days when they drop doctors from their provider networks.
Health insurers will be required to continue coverage for several months for serious conditions such as cancer, heart disease and pregnancy at no extra cost when their in-network doctors drop out of an insurer’s network. The in-network coverage lasts for 90 days or until the end of the policy’s term, and during that time the insurer cannot impose higher deductibles or premiums. It affects all group or individual health insurance policies in the state.
The bill was pushed by the late state Rep. Cathy Harvin, a Summerton Democrat who died from complications of breast cancer Dec. 4, and was supported by the South Carolina Medical Association. Harvin’s colleagues said doctors being dropped from health insurer’s networks sometimes made Harvin’s own cancer fight more expensive.
“She was penalized because of those very issues,” said Sue Berkowitz, executive director of the advocacy group South Carolina Appleseed Legal Justice Center.
That personal experience drove Harvin to push the legislation, said House Democratic Leader Harry Ott of St. Matthews.
Under current law, consumers can pay higher deductibles and out-of-network charges when an insurer and doctor part ways and the patient wants to continue seeing the same care provider.
Berkowitz said people are caught in the middle. “Why should you be penalized because the insurance company doesn’t want to pay the doctor the rate he says he needs to operate his business?” she said.
And it can be a major expense and disruption at the worst time. “You should not have to be faced with those kinds of decisions being thrown at you,” Berkowitz said.
That changes with the new law, Ott said.
“All these patients now have a degree of certainty that they’re not going to get kicked out in the cold and they’re going to have some access to treatment. Hopefully that will be a legacy that people will remember Cathy for,” he said.
At a minimum, Berkowitz said, the extra time gives people the chance to plan for their care and added expenses and possibly switch insurers.
The South Carolina Medical Association supported the bill, said Dr. Greg Tarasidis, the association’s president.
“There can be instances where a patient may find themselves caught between contractual negotiations among their physician and insurer and end up paying a higher co-payment to remain with their doctor or be forced to find a new doctor in the middle of treatment,” said Tarasidis, a Greenwood ear, nose, and throat physician.
BlueCross and BlueShield of South Carolina, the state’s largest health insurer, declined to comment and referred questions to the South Carolina Alliance of Health Plans, a trade group. Jim Ritchie, the alliance’s director, did not respond to calls and messages left seeking comment.
The legislation moved through the House with few objections in 2009. Earlier this year, it cleared the Senate with just two of 46 senators voting against it. The House gave it final approval with a 103-0 vote.
State Sen. Kevin Bryant, an Anderson Republican, voted against the measure and said it is a mandate on private sector insurance.
“And it’s government getting involved in a private contract and I just have some bad feeling about it,” Bryant said.
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