South Carolina’s population is approximately 25.9% Black, one of the highest percentages in the nation. The state’s history of racial inequality is deeply intertwined with its healthcare system. As recently as the 1960s, it was not uncommon to find medical clinics and hospitals operating with separate entrances and waiting rooms for White and Black patients. Although federal civil rights laws ended legal segregation decades ago, significant health disparities continue to persist across South Carolina.
South Carolina ranks among the states with the highest prevalence of diabetes in the United States. The burden of diabetes and its complications is not distributed evenly. The disease is concentrated in poorer counties, particularly those along the Interstate 95 corridor, often referred to as the “Corridor of Shame.” This region has long struggled with high poverty rates, underfunded schools, limited healthcare access, and chronic shortages of public resources. It is also home to some of the highest percentages of Black residents in the state.
The consequences are visible in health outcomes. For years, some of South Carolina’s highest rates of diabetes-related lower-extremity amputations have occurred in rural and predominantly Black communities. Despite advances in medical science and improvements in diabetes treatment, residents of these communities continue to experience dramatically worse outcomes than those living in more affluent areas.
A striking example can be found by comparing two South Carolina ZIP codes.
Richland County’s 29203 ZIP code has historically experienced some of the state’s most concerning health outcomes, including elevated rates of diabetes complications and amputations. Unlike many underserved communities, 29203 is not located in a remote rural county. It sits only minutes from the South Carolina State House, where lawmakers make decisions affecting healthcare policy. The ZIP code is also home to major healthcare institutions, including facilities operated by Prisma Health.
In contrast, Lexington County’s 29072 ZIP code presents a very different picture. The community is relatively affluent, predominantly White, and served by Lexington Medical Center, one of South Carolina’s most highly regarded healthcare systems. Lexington Medical Center has built an extensive network of clinics throughout the county, providing residents with convenient access to primary care and specialty services. Health outcomes in the area consistently outperform those seen in many underserved communities across the state.
Why do two communities located only a few miles apart experience such different healthcare realities?
Why are healthcare systems in affluent communities expanding while providers serving vulnerable populations struggle to survive?
These questions become even more important when examining the challenges faced by community-based providers. Eau Claire Cooperative Health Centers, founded by Black physicians to serve historically underserved neighborhoods in Richland County, was created because many residents lacked adequate access to healthcare. For decades, organizations such as Eau Claire filled critical gaps in care. Yet in recent years, financial pressures have forced clinic closures and service reductions.
At first glance, many observers assume these differences result from management decisions, physician performance, or patient demographics. However, another factor deserves closer scrutiny: the economics of healthcare reimbursement.
I operate an urgent care clinic in Lexington County. Despite serving record patient volumes—often seeing 80 to 90 patients per day—I frequently found myself struggling with the same financial pressures affecting clinics across South Carolina. After seven years in practice, I began asking a simple question: How can some healthcare organizations consistently expand while others struggle to remain open?
The answer led me to one of the least transparent aspects of healthcare finance: physician fee schedules.
A physician fee schedule is essentially a pricing document that assigns a reimbursement amount to each medical service identified by a CPT code. Much like a restaurant menu lists prices for food items, a fee schedule determines how much a health insurer will pay for a particular medical service.
In South Carolina, BlueCross BlueShield of South Carolina dominates the commercial insurance market. For most physician practices, participation in the BlueCross network is essential for survival. Without a contract, many clinics would lose access to a significant portion of insured patients.
Fee schedules, however, are generally treated as confidential documents. Providers are often prohibited from sharing them publicly, making it difficult for physicians to compare reimbursement rates across organizations.
As I investigated reimbursement practices, I discovered substantial variations in payments for identical services provided by different healthcare organizations. In some cases, providers received dramatically different reimbursement amounts for the same CPT code despite delivering comparable services to patients covered by the same insurer.
If these differences are widespread, they could have significant consequences. Higher reimbursement rates generate revenue that can be reinvested into hiring physicians, opening new clinics, purchasing equipment, and expanding services. Lower reimbursement rates leave providers with fewer resources to invest in patient care and community growth.
The result is a cycle in which well-funded healthcare systems continue to expand while safety-net providers serving vulnerable populations face mounting financial challenges.
This raises important public policy questions.
What factors determine reimbursement rates between insurers and providers?
Are reimbursement disparities contributing to healthcare access gaps across South Carolina?
Do current contracting practices unintentionally reinforce longstanding racial and economic inequalities?
These questions deserve careful examination by policymakers, regulators, healthcare leaders, and the public.
BlueCross BlueShield of South Carolina occupies a unique position within the state’s healthcare system. Because of its market influence and its role in administering health benefits for large public and private employers, its reimbursement policies affect healthcare access for hundreds of thousands of South Carolinians.
State officials, legislators, and regulatory agencies should ensure that reimbursement systems promote equitable access to care and do not inadvertently disadvantage providers serving historically underserved communities. Greater transparency in physician reimbursement could help policymakers better understand whether payment disparities are contributing to unequal healthcare outcomes.
Let’s compare apples to apples. For example, if you visit a podiatrist in Lexington County owned by Lexington Medical Center, BlueCross BlueShield of South Carolina (BCBS) pays approximately $225 for CPT code 99204, a new patient office visit. In another ZIP code, if you visit a podiatrist practice owned by Black physicians and serving predominantly Black patients, such as Eau Claire Cooperative Health Centers or Physicians Foot Care, the reimbursement is closer to $100 for the exact same service. Likewise, if the podiatrist orders a foot X-ray, Lexington Medical Center receives approximately $78.81 for CPT code 73630, while Eau Claire and Physicians Foot Care receive about $35 for performing the identical service.
The State of South Carolina has significant leverage in this discussion. BlueCross BlueShield of South Carolina administers health insurance benefits for hundreds of thousands of state employees and their families, making the state one of the company’s most important clients. State officials should use that influence to ensure that reimbursement policies are fair, transparent, and do not contribute to unequal access to healthcare.
South Carolina has spent decades dismantling the legal barriers of the Jim Crow era. Any payment system that disproportionately disadvantages providers serving Black communities deserves careful public scrutiny. Healthcare reimbursement should be based on objective standards and quality of care—not on a provider’s location, ownership structure, or the demographics of the patients they serve.
About: Lachin Hatemi, M.D.
Dr. Lachin Hatemi is a physician and alumnus of the University of Kentucky College of Medicine. After completing a surgical internship at the University of Kentucky, he completed his residency training at the University at Buffalo in New York.
Dr. Hatemi is the founder and owner of Veritas Health Group, a healthcare organization headquartered in Lexington, South Carolina, that owns and operates several urgent care clinics throughout the Midlands.
A lifelong civil rights advocate, Dr. Hatemi is committed to advancing equity and equality in healthcare. He is a leading voice for fair reimbursement of independent physicians by commercial health insurance companies, with a particular focus on ensuring equitable payment practices by BlueCross BlueShield of South Carolina. Through his advocacy and writing, Dr. Hatemi works to raise awareness of disparities in physician reimbursement and to promote policies that improve access to high-quality, independent medical care.
Lachin Hatemi, M.D. – Veritas Health Group LLC.247 Columbia Avenue, Lexington, SC 29072 Email Address: lachinhatemi@gmail.com
