A proposed South Dakota ballot measure would prohibit insurance companies from restricting their customers’ choice of out-of-network health care providers.
The proposed law, sponsored by three South Dakota doctors, would allow any health care provider to take part in an insurance company’s network as long as the provider is willing to meet the company’s terms and conditions and operates within the company’s coverage area, The Argus Leader reported.
The concept, called “any willing provider,” would let health providers decide if they want to participate with a health insurance company, rather than allowing an insurer to set up a restrictive network of providers.
Supporters of the proposal need 15,855 petition signatures from registered voters to get on next year’s statewide ballot.
A similar measure was defeated earlier this year by the South Dakota Legislature and had been opposed by business groups, insurance companies and the state’s three large hospital systems.
The proposal’s supporters argue it gives patients a choice of where they are treated, while opponents say those plans are more expensive.
Dr. Stephen Eckrich, an orthopedic surgeon at Black Hills Orthopedic & Spine and one of the sponsors of the petition effort, predicts voters will embrace the idea of patient choice.
“Who would be against patients allowing themselves to choose their own doctor?” he said.
Eckrich said selective networks disrupt longstanding patient-physician relationships. He said he lost two patients recently when they changed insurance companies and his office wasn’t in their networks.
“To me, that’s going to be the end of good health care as we know it,” Eckrich said.
Sponsors of the failed bill argued the large hospital systems, which are also in the insurance business, are trying to cut out competing providers and funnel patients to providers who work for the hospitals.
Dave Hewett, president of the South Dakota Association of Healthcare Organizations, said the insurance market already offers individual and employer insurance plans that give patients a choice of providers. However, those plans are more expensive, he said.
“Those who want more choice and are willing to pay for it have that option,” Hewett said.
Restrictive networks allow insurance companies to negotiate lower rates with providers in the network for a guarantee of higher patient volume, but allowing patients to go to any willing provider could drive up the cost of health care, Hewett said.
Hewett said insurance plans often allow people to use out-of-network providers, but those who do have to pay more.