SIOUX FALLS, S.D. – After months of engaging in good faith negotiations and extensive discussions with Wellmark on important terms impacting patients in South Dakota, Sanford Health has issued Wellmark a notice of contract termination, effective July 1, 2027. Sanford Health believes patients deserve healthcare agreements that ensure stability, certainty and protect access to care within their communities, and Wellmark has been unwilling to compromise on its demands for exclusive control of decisions affecting patient care.
Patients rely on stable access to their doctors, hospitals and healthcare services. Wellmark insists on having sole authority to change key contract terms after an agreement is signed, including terms that affect how patients receive care and how that care is paid for. Patients are best served when decisions affecting their care, access and affordability are made collaboratively by healthcare providers and insurers. Those decisions should not be controlled solely by an insurance company.
“Our patients come first. Decisions affecting access to care and the future of local healthcare services must be mutually negotiated, not dictated by Wellmark,” said Nick Olson, executive vice president, chief financial officer at Sanford Health. “We cannot accept a contract that gives an insurance company the power to change the terms on its own, with consequences for the care our patients and communities depend on.”
Wellmark is seeking a long-term agreement to lock in their ability to make exclusive changes after the contract is signed and control terms that impact patient care. Sanford supports multi-year agreements when they provide clear expectations, certainty and stability for patients, providers and communities. Achieving that stability also requires market-appropriate reimbursement rates that keep pace with the cost of care, enabling Sanford to sustain local services and reinvest in its communities.
Rural communities depend on local hospitals, clinics, physicians, emergency care and specialty services close to home. Maintaining those services requires the flexibility to collaborate with independent physician groups, long-term planning and investments in the workforce, facilities and programs that patients rely on every day.
Patients deserve the confidence that the terms affecting their care, access and coverage will not change unexpectedly. Sanford believes important contract changes should be negotiated and agreed upon by both organizations rather than implemented by one party alone.
When healthcare providers face ongoing uncertainty about how care will be reimbursed or what contract terms may change in the future, it becomes more difficult to plan for the services communities need most. That uncertainty can make it harder to sustain the healthcare services patients rely on, expand access to specialty care and keep care close to home.
“Patients in rural communities should not have to travel farther or wait longer to receive care because of decisions made by an insurance company,” said Joshua Crabtree, M.D., chief physician at Sanford Health. “Also, patients should not have to choose between affordable health insurance and access to trusted local healthcare providers. Both matter. Health insurance is most valuable when patients can use it to access the doctors they trust and the hospitals and services they need, when and where they need them. Healthcare contracts should support affordability while also protecting access to care close to home.”
Today, Sanford Health remains in network with Wellmark, and there are no changes to patients’ coverage or benefits. Appointments, procedures and treatments will continue as scheduled. The notice of contract termination is effective July 1, 2027, which gives Sanford Health and Wellmark eight months to reach terms that protect patients.
Sanford remains committed to reaching an agreement that protects patients, preserves access to local healthcare services and supports the long-term health of the communities we serve. That includes maintaining access to critical services that patients across the region rely on, including South Dakota’s only Level I Adult Trauma Center and Level II Pediatric Trauma Center at Sanford USD Medical Center in Sioux Falls.
South Dakota patients can learn more about the facts by visiting: sanfordhealth.org/lp/insurance-updates
This primarily affects Wellmark members but may also impact BlueCard patients seeking care at Sanford Health locations in South Dakota and Iowa.
South Dakota patients may reach out to their insurance company with questions or concerns about their current coverage and options available by calling the number on the back of their member card.
About Sanford Health
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the healthcare experience and providing access to world-class healthcare in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization has 60,000 employees and serves more than 2.5 million patients and nearly 415,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 60 hospitals, 315 clinic locations, 145 senior care communities, 4,900 physicians and advanced practice providers and 1,100 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to nearly 80 specialties. Nearly 450 residents and fellows are trained each year through over 40 graduate medical education programs, with Sanford Health serving as the primary funding source for 75% of the programs. Sanford Health also includes 92 retail pharmacies, including Sanford and Lewis Drug pharmacies with locations in 6 states, and more than 300 pharmacists. Learn more about Sanford Health’s commitment to shaping the future of rural healthcare across the lifespan at sanfordhealth.org or Sanford Health News.
…
Posted In Company News, General, Health Information, Health Plan, Healthy Living, Here for all. Here for good., News, Sioux Falls
