Under the so-called patient choice provision adopted in 2014, South Dakota health insurers are required to include all health providers in their networks so long as providers accept the plan’s reimbursement terms.
Here are six things to know about the lawsuit.
1. Sanford argued it can continue to offer narrow network plans so long as it also offers a plan open to all providers.
2. Sioux Falls Specialty Hospital objected to Sanford’s decision to continue offering narrow network plans that excluded some providers. Narrow networks consist of a smaller universe of providers that typically consent to reduced reimbursement rates in exchange for higher patient volumes.
3. Sioux Falls Specialty Hospital filed a suit against Sanford, demanding the health plan allow the hospital access to all of Sanford’s health plans.
4. The judge rejected both SFHS’s request and Sanford’s interpretation of the patient choice law.
5. In his ruling, the judge established an arbitration process by which SFSH can submit a list of services to Sanford for network consideration, and Sanford can offer a take-it-or-leave-it set of reimbursement terms and conditions.
6. Sanford officials expressed support for the judge’s decision, according to Argus Leader. SFSH officials have not yet issued a response.
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