South Carolina Code 38-71-1950. Requests for external review
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(A) All requests for external review must be made in writing to the health carrier.
(B) A covered person or his authorized representative may make a request for an external review of an adverse determination or final adverse determination only when the amount payable for covered benefits is at least five hundred dollars.
Terms Used In South Carolina Code 38-71-1950
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
(C) A covered person is not entitled to an external review of a retrospective review determination unless the covered person has exhausted the health carrier’s internal appeal process and may be held financially responsible for the covered benefits.