State Detail

South Carolina

6 plans reporting · CY 2025

Across 6 plans reporting in South Carolina, standard prior authorization denial rates range from 1.1% to 21.5%, averaging 13.4%. Among plans reporting appeal outcomes, 61.6% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.

Plan Comparison

		Standard												Expedited
Plan	Org	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days	Requests	Approved	Denied	Appr %	Denial %	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days	Source
BlueCross BlueShield of South Carolina
BlueCross BlueShield of South Carolina Medicare Advantage PPOMedicare Advantage	BlueCross BlueShield of South Carolina	—	—	—	98.9%	1.1%	—	52.0%	48.0%	—	—	1.8	1.0	—	—	—	99.7%	0.3%	—	—	—	—	—	1.0	0.0	View source ↗
Centene Corporation
Ambetter from Absolute Total CareExchange Plans	Centene Corporation	99,318	78,008	21,310	78.5%	21.5%	1,646	56.8%	43.2%	0.0%	100.0%	4.0	1.0	4,020	2,938	1,082	73.1%	26.9%	254	66.5%	33.5%	1.9%	98.1%	1.0	0.0	View source ↗
Absolute Total Care - SC Medicaid MCO (Centene)Medicaid MCO	Centene Corporation	56,881	46,800	10,081	82.3%	17.7%	719	52.7%	47.3%	0.0%	100.0%	4.0	1.0	989	781	208	79.0%	21.0%	108	56.5%	43.5%	0.0%	100.0%	1.0	1.0	View source ↗
Wellcare Medicare Advantage (H7326)Medicare Advantage	Centene Corporation	32,752	27,972	4,780	85.4%	14.6%	413	97.8%	2.2%	0.0%	0.0%	4.0	2.0	3,981	3,303	678	83.0%	17.0%	73	100.0%	0.0%	0.0%	0.0%	1.0	1.0	View source ↗
Humana Inc.
Humana Healthy Horizons South CarolinaMedicaid MCO	Humana Inc.	14,667	13,074	1,593	89.1%	10.9%	48	43.8%	56.3%	0.0%	0.0%	3.0	2.0	3,799	1,541	2,258	40.6%	59.4%	—	—	—	0.0%	0.0%	0.4	0.3	View source ↗
InStil Health
InStil Health Insurance Company (Individual QHP)Exchange Plans	InStil Health	—	—	—	85.4%	14.6%	—	66.7%	33.3%	—	—	4.0	1.0	—	—	—	83.2%	16.8%	—	—	—	—	—	1.9	1.0	View source ↗