Woods Fuller Clients Prevail in the South Dakota Supreme Court

The South Dakota Supreme Court held that Sanford Health Plan can no longer exclude non-Sanford medical providers who are willing and fully qualified to treat insureds of Sanford’s various health insurance plans. 

 Despite the passage of Initiated Measure 17 in 2014, commonly known as the Any Willing Provider Law, Sanford Health Plan continued to exclude the vast majority of medical providers from some of its plans to the extent such providers were not affiliated with the Sanford Health system.  The insureds covered by those health insurance plans were required to pay 100% out-of-pocket if they chose to treat with non-Sanford Health providers for non-emergent medical services.  As a result, Woods Fuller brought a legal action against Sanford Health Plan on behalf several independent medical providers and facilities, including the Orthopedic Institute, Sioux Falls Specialty Hospital, and Ophthalmology Ltd. 

 The case was heard by a Second Circuit Judge in December of 2022, and it resulted in a ruling in favor of Woods Fuller’s clients.  Sanford Health Plan subsequently appealed the decision to the South Dakota Supreme Court. 

 The Supreme Court published its opinion on February 8, 2024, and it held that Sanford Health Plan’s exclusion of willing and fully qualified medical providers violated the Any Willing Provider Law and obstructed patient choice.  The Supreme Court’s decision was unanimous and authored by Chief Justice Steven Jensen.