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Most Common Health Insurance Claims in South Carolina

Healthcare spending in South Carolina actually ranks near the bottom of the list among all states. According to the Centers for Medicare & Medicaid Services, the state ranked 44th for healthcare spending per person, sitting at $10,242 in 2020. 

While that is certainly great news for individuals, businesses and other organizations in the state, it’s still very expensive — painting a true picture of how high healthcare expenses have gotten in the U.S. 

A large percentage of these healthcare expenses are processed through health insurance policies in the state. But, what are the most common health insurance claims in South Carolina? 

We look at just that below. 

What Are Medical Claims? 

Before diving into the most common health insurance claims, it’s important to understand what a claim is. Just about every time that a health insurance subscriber incurs a medical expense, it runs through the health insurance plan first. 

For instance, when a member visits an in-network doctor, the bill for that visit is first submitted by the doctor to the insurance company. That insurance company then uses the unique codes that are on the bill to determine what services are covered, whether certain expenses are not billable, and what the member is responsible for paying. 

Once the medical claims are processed by the insurance company, an EOB — or explanation of benefits — is sent to member to notify them of their responsibility. The doctor’s office receives a similar notice, and then sends a bill to the member for the outstanding amount. 

Most Common Health Insurance Claims in South Carolina 

Health insurance claims fall under three major buckets in South Carolina — medical, dental and pharmacy.  

Medical 

Medical claims refer to any visit to a doctor or medical facility. This could include primary care physicians and urgent care facilities; specialists such as orthopedics, physical therapists, chiropractors and more; and visits to the emergency room or hospital. 

Any doctor or facility that provides care for your body would fit under the medical claims umbrella. This could include care such as a procedure, a diagnosis and a routine preventative visit. It could also include medical devices, medical supplies and even medical transportation services. 

Dental 

Any visit to a dentist, oral surgeon or orthodontist will fall under dental care on a health insurance policy. Again, this could be for any care that you receive at one of these offices — routine cleaning and x-rays, braces, teeth pulling and root canals, for instance. 

While dental care used to be covered under most health insurance plans, it unfortunately isn’t as common today. This has resulted in many people in South Carolina either having to obtain separate dental insurance on their own or pay out of pocket for all dental expenses. 

Pharmacy 

Pharmacy claims include any prescription that a doctor has written for you that you pick up from a local pharmacy. This could include regular prescriptions such as those that help treat diabetes, high blood pressure and cholesterol, and they can include “one-off” prescriptions such as antibiotics. 

In most cases, these health insurance claims will be processed instantly, with you paying your responsibility at the time that you pick up your prescription. If you have a mail order of regular prescriptions, though, you might receive a traditional EOB and bill from the provider, like you do for medical and dental claims. 

Some health insurance plans today also allow you to submit reimbursement requests for other items that can be purchased at a pharmacy. This could include over-the-counter medications and vitamins, everyday medical supplies and more.  

It’s important to check the details of your health insurance plan to see what, if anything, might be covered under this umbrella. 

Work with Beckham Insurance Group to Lower Health Insurance Claims 

Employers in South Carolina have a challenging job today dealing with the increasing cost of health insurance plans. These costs are rising for both the employer and their employees on a seemingly annual basis. 

Navigating the muddy waters of health insurance can be a difficult if not impossible job for employers. That’s why it makes sense to work with an experienced health insurance benefits company such as Beckham Insurance Group. 

If your business is located in the South Carolina or Georgia region, Beckham Insurance Group can help you design a health insurance plan that works for you and your employees — one that serves them well and helps lower the cost of health insurance claims. 

Contact us today to learn more.