A decade-long battle between health care providers has ended in the South Dakota Supreme Court, with a victory for an independent physician group.
The court on Thursday upheld a lower court ruling against Sanford Health Plan, requiring Sanford to include qualified physicians, optometrists and nurses as members of the plan’s health care provider committee. . Physicians from the Orthopedic Institute led the lawsuit against Sanford, with other independent physician organizations joining.
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Independent health care providers sued Sanford in 2021 after Sanford Health Plan continued to exclude independent health care providers from some of the plans it offers to businesses and individuals. A person covered by this plan was required to pay his 100 percent of the cost out-of-pocket if he chose to be treated by an independent physician.
The independent providers argued that Sanford’s actions violated a voter-approved 2014 ballot measure called “any provider.” The Voluntary Provider Act, which won with 62 percent of the vote, would make eligible health care providers available as long as the health care professional resides in the geographic area covered by the plan and the provider is willing. It stipulated that a person cannot be excluded from the Insurance Commission. Meet the terms and conditions of your insurance plan.
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