The Hidden Costs of Healthcare: Why South Carolinians Need Billing Transparency & a Right to Shop
One of the scariest financial burdens on the average American citizen is their trip to a hospital. Without protections for health care billing transparency, individuals often walk into a hospital to receive help, unaware of the hefty bill that will inevitably hit their mailbox weeks later.
Take, for example, the case of Amanda Partee-Manders, a mother of three heading to the hospital to deliver her fourth baby by C-Section. After giving birth, Amanda requested to see her itemized bill, a right of patients granted by President Trump’s 2019 executive order.
Amanda was shocked to find the total cost of her hospital stay came out to $47,091! Most shockingly, after a friend helped her dig into the billing codes, Amanda found a $4,000 charge for just a few doses of Tylenol. If she had been able to compare costs of hospitals in her area, she would have found that another hospital offered that same Tylenol via IV for thousands of dollars less.
Amanda’s costs could have been lower if she had the option to compare prices beforehand.
Patients deserve the right to shop for healthcare to find the best price and service for their medical procedures. Medical bills should not simply become available after the service is already provided. The ability to view price differences prior to receiving services could make a huge budget difference in the wallets of many consumers, and it empowers patients to weigh factors like doctor quality/expertise, price, location, and more to make their decisions.
A January 2025 study by Massachusetts-based health care cost containment firm The PHIA Group ranked South Carolina forty-eighth in the nation in terms of healthcare quality and cost analysis. This ranking indicates that the quality of care available in South Carolina, compared to the costs of care, puts us among the worst in the country. Unpredictable, surprise medical bills are a key contributor to this poor ranking.
Federal Legislation
President Donald Trump’s February 25 Executive Order requires disclosure of the actual prices of medical services, and not just estimates across all health care facilities. The goal of this action is to ensure that American patients can get the best help for their price point.
This executive order would greatly benefit patients’ ability to shop between medical facilities before committing to a costly procedure. This order extended a 90-day period for all facilities to fall into compliance, putting the date of action on May 26. It is our hope that Trump’s Administration will be able to crack down on compliance across all facilities in the U.S.
“Our goal was to give patients the knowledge they need about the real price of healthcare services. They’ll be able to check them, compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost. And this is about high-quality care. You’re also looking at that. You’re looking at comparisons between talents, which is very important. And then, you’re also looking at cost. And, in some cases, you get the best doctor for the lowest cost. That’s a good thing.”
Additionally, the No Surprises Act (NSA) was signed into law on December 27, 2020, and went into effect January 1, 2022. The purpose of this act is to protect consumers from surprise medical bills with special attention to those that result from out-of-network care or bills. However, this act has its limitations, such as those pointed out by the SC Department of Insurance (SC DOI), including not protecting patients from surprise billing for ground ambulances and any other facilities aside from emergency departments, hospitals, and ambulatory surgical centers. Services at urgent cares and clinics are not currently protected from surprise billing. But for most other medical services, notices are now attached to all medical bills notifying patients of this change in protections. Unfortunately, the No Surprises Act does pass costs on to consumers in the form of higher insurance premiums, a lesson in unintended consequences and the importance of getting policy right the first time.
What Can We Do in South Carolina?
In last year’s legislative session, H.4622, authored by Rep. Heath Sessions (R-York), passed the House unanimously. Dr. Oran Smith testified on this bill when it was in subcommittee. Unfortunately, the proposal died in the Senate Medical Affairs committee after only one hearing. This bill required health care providers to present to patients an itemized bill, written in plain language, and submitted no later than 30 days after the final payment has been requested. While this bill did not propose any policies allowing patients to be able to shop around for medical services, it did allow for greater transparency within the world of medical billing.
A new version of this bill, H.4069, was filed by Rep. Sessions early in the 2025 session, and once again, it passed the House unanimously. The bill is nearly identical to the 2024 bill, but it allows patients to opt out of receiving itemized bills and indicate whether they prefer electronic or paper for the bill. Additionally, the legislation removes a time frame for the bill to be posted but makes sure that healthcare providers cannot pursue debt collection until the itemized bill is provided to the patient.
While this bill brings much needed transparency to medical billing across the state, the requirement to post a clear, itemized bill AFTER a procedure is really the bare minimum, and something that healthcare providers really should already be doing. The fact that the Senate Medical Affairs committee last year decided this was too burdensome for hospitals is astounding!
We need bold reform to truly eliminate surprise billing and give South Carolina patients the right to shop for their healthcare.
Past Efforts in South Carolina
Surprise Billing
“Surprise billing” occurs when an insured patient received medical care from an in-network provider but receives a bill by an out-of-network provider at the in-network facility. Most likely, the patient did not knowingly elect to obtain services from this out-of-network provider and finds themself shocked to get their bill in the mail.
In the 2021-2022 legislative session, Representative Garvin (D-Richland) sponsored H.3401 to end the practice of surprise billing within all South Carolina medical facilities. This bill would have made it so that an insured patient would only be required to pay the applicable copayment/deductible that would be imposed for such a health care service if the service was rendered by an in-network health care provider. This same bill saw life again in the 2023-2024 session as S.185, sponsored by former Senator Fanning (D-Great Falls), but unfortunately again saw no movement.
Itemized Patient Billing
Shockingly, many not most healthcare facilities, do not provide patients with a clear itemized bill showing exactly how their money is being spent. Many facilities that do offer this provide their bill in coded medical language that is not easy to read for the average citizen. Legislation requiring itemized patient billing in plain language would create a uniform standard across our state and help patients better understand their care and medical billing. Rep. Sessions’ bill H.4069 falls in this category and should be a no-brainer for legislators to pass.
Right to Shop
“Right to Shop” refers to the idea that consumers have the ability to compare prices, services, and providers while making decisions about their healthcare treatment. Price transparency is a must for patients to be able to shop around for the best and most cost-efficient service.
In the 2015-2016 legislative session, Senators Davis (R-Beaufort) and Massey (R-Edgefield) sponsored S.1221, which was called the “Right to Shop Health Insurance Act.” This bill would have encouraged insured patients to shop around for more affordable health care treatments by establishing an incentive program within their insurance. Patients would have been offered at least 40% of the insurance carrier’s saved cost for each service or category of shoppable health care services. This bill was reintroduced in later sessions as S.991 (2019-20), S.289 (2021-22), and S.175 (2023-24), with support from Senator Climer (R-York). We have not yet seen it filed in 2025.
Another bill on the issue was S.400, sponsored by Senator Davis and Turner (R-Greenville). during the 2017-2018 legislative session. This bill was titled the “South Carolina Right to Shop Act” and stated that upon request by a patient, a health care provider within the patient’s insurance must disclose the allowed amount for the nonemergency service, procedure, or admission. If the health care provider is unable to quote a specific amount, then the provider must propose what amount is known. An incentive program would be developed by insurance companies to encourage individuals to shop around for more affordable health care treatments. This incentive program would give enrollees at least 50% of the carrier’s saved costs for each service or category of shoppable health services.
Right to Shop bills truly bring the free market into the healthcare sector, empowering and encouraging patients to make the best decisions for themselves and not letting monopoly healthcare services shock patients with outrageous charges after procedures.
Other State Efforts
South Carolina has fallen behind other states in the healthcare quality index, and our lack of medical freedom policies can be held partially responsible. Under the Trump administration, price transparency and right to shop policies have become hot ticket items in statehouses across the nation. Last year, Arkansas passed H.1452, mandating that all hospitals across the state comply with price transparency guidelines to make pricing easily accessible online for patients.
In a study by the University of Maryland’s Hilltop Institute, researchers found no available data on healthcare price transparency in South Carolina, and unlike many states across the nation, we lack any sort of law on the topic. The chart below shows states that have adopted recent price transparency legislation and made pricing data publicly accessible.
Source: Price Transparency State Profiles, Hilltop Institute, 2024
Our Hopes
Health care services are a financial burden that can deliver severe financial blows to families. The state legislature can easily reduce this burden by giving patients the information and ability to shop around and make their own decisions. But this requires transparency in medical pricing, BEFORE any procedure. Not only should individuals have the right to be provided easy-to-understand itemized bills after the fact, but medical facilities should also do their best to provide accurate estimates of what prices can be expected before standard medical procedures.
You shop around for the best price on cars, groceries, and dry-cleaning. Healthcare should not be any different.
We are glad that the first Trump administration took action to enhance price transparency, and we’re delighted to see his second administration continue the cause. The 125th South Carolina General Assembly for steps toward healthcare freedom by repealing Certificate of Need laws in our state, and we hope to see the positive trajectory continue with H.4069 and further right to shop bills.
