Independent doctors win dispute with health systems over insurance access
S.D. Supreme Court interprets 2014 Any Willing Provider Law
A decade-long battle among health care providers has run its course in the South Dakota Supreme Court, with victory going to a group of independent physicians.
The Court upheld a lower court ruling against Sanford Health Plan Thursday, requiring Sanford to include qualified physicians, optometrists and nurses as part of its panel of providers in its insurance plans. Physicians from the Orthopedic Institute led the lawsuit against Sanford and were joined by other independent physician groups.
The independent providers sued Sanford in 2021 after Sanford Health Plan continued to exclude them from some of the plans offered to businesses and individuals. Those covered in the plans were required to pay 100 percent of expenses out of pocket if they chose care from one of the independent physicians.
The independent providers argued Sanford’s conduct violated a 2014 ballot measure – dubbed Any Willing Provider – that voters approved. The Any Willing Provider Law, which won with 62 percent of the vote, stated that no health insurance company could exclude qualified health care providers from their insurance panels, provided the health care professionals were located in the geographic areas covered in the plans and willing to meet the terms and conditions of the insurance plans.