Standing up for SD & IA patients in our negotiations with Wellmark
Last updated Oct. 26, 2026
Sanford Health and Wellmark have reached an impasse in negotiations to renew our commercial contracts in South Dakota and Iowa. Because we were unable to reach agreement on important terms impacting patients, Sanford Health issued a notice of contract termination effective July 1, 2027. Sanford believes patients deserve healthcare agreements that ensure stability, certainty and protect access to care within their communities.
What you need to know now
Today, Sanford remains in network with Wellmark, and there are no immediate changes to your coverage or benefits. Appointments, procedures and treatments will continue as scheduled.
Sanford has issued a notice of contract termination effective July 1, 2027. Our preference remains a negotiated agreement, and this notice period gives Sanford and Wellmark nine months to reach terms that protect patients. Sanford is ready to continue discussions, but an agreement can only be reached if both parties are willing to engage.
In the meantime, patients should continue receiving care as usual while reviewing their coverage and available options for 2027. Patients who receive insurance through an employer or insurance broker should ask about available coverage options and whether their preferred Sanford providers and facilities will be in network. Patients purchasing coverage through the Health Insurance Marketplace should carefully review plan networks, benefits and out-of-pocket costs.
The potential impact is primarily concentrated among Wellmark members receiving care at Sanford Health locations in South Dakota and Iowa. Patients using BlueCard coverage may also be affected, depending on their plan and where they receive care. Lewis Drug locations and Good Samaritan facilities are not affected.
Patients deserve stability and certainty in the healthcare decisions that affect them
Patients rely on stable access to their doctors, hospitals and healthcare services. Wellmark insists on having the sole authority to change key contract terms after our agreement is signed, including terms that affect how patients receive care and how that care is paid for.
Imagine signing a cell phone contract that spells out your monthly bill, the services included and where you have coverage—but gives the phone company sole authority to change those terms after you sign, without your agreement.
That illustrates our concern: an agreement should provide certainty about what both sides are committing to. When contract changes affect patients’ care, access or costs, providers and insurers should agree on those changes together. Those decisions should not be controlled solely by an insurance company.
In our experience, other payer relationships operate through negotiation and mutual agreement when substantive contract changes are proposed. Wellmark has a history of exercising broad control to change terms in a way that materially affects providers, patient care and agreed upon reimbursement. Similar practices have drawn concerns from hospital associations and policymakers in several states, with some states enacting legislation to prohibit them. Iowa just passed legislation in 2026 focused on addressing Wellmark’s specific practices.
Stability also depends on market-appropriate reimbursement rates and predictable contract terms. Reliable reimbursement helps Sanford recruit and retain clinicians, sustain local healthcare services and continue investing in specialized care so patients can access the care they need close to home.
Sanford supports multi-year agreements when they provide stability and clear expectations for patients, providers and communities. That stability requires market-appropriate reimbursement rates and predictable contract terms.
Patients deserve confidence that decisions affecting their care, access and coverage will be made through collaboration between healthcare providers and insurers and not changed by one party after an agreement is reached. Without that certainty, it becomes more difficult to sustain local healthcare services, expand specialty care and keep care close to home.
How Wellmark’s proposed contract could hurt rural communities
Rural communities rely on local hospitals, clinics, physicians, emergency care and specialty services. Sustaining those services requires long-term planning, investment and financial stability.
When healthcare providers face uncertainty about reimbursement and contract terms, it becomes more difficult to invest in the workforce, facilities and services communities need most. That uncertainty can make it harder to maintain local care, expand access to specialty services and keep patients from having to travel farther for care.
Patients in rural communities should not have to travel farther or wait longer for care because of decisions made by an insurance company. Sanford believes healthcare contracts should strengthen local healthcare systems and preserve access to care close to home.
Patients deserve both affordable coverage and reliable access to care
Health insurance is most valuable when patients can use it to receive care from the physicians they trust and the hospitals and services they need. Affordability includes more than premiums. It also includes deductibles, copays, prescription costs, travel, childcare and time away from work. Healthcare contracts should support affordable coverage while protecting access to high-quality care close to home.
Sanford remains committed to reaching a fair, sustainable agreement that protects patients, preserves access to local healthcare services and supports the long-term health of the communities we serve. That includes market-appropriate reimbursement, dependable contract terms and continued access to critical services 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.
Information for employers offering Wellmark coverage
Sanford Health recognizes that employers need clear information to make coverage decisions and answer employees’ questions. If your organization offers Wellmark coverage, there are no immediate changes to employees’ benefits, access to Sanford providers or scheduled care. Sanford remains in network with Wellmark through July 1, 2027.
However, if Sanford and Wellmark do not reach an agreement, Sanford would become out of network with Wellmark on July 1, 2027. Employees can still receive care from Sanford providers and facilities, but their coverage and out-of-pocket costs would depend on the terms of their Wellmark plan.
Employers should review their current coverage arrangements and speak with Wellmark and their benefits adviser about the potential impact on employees. Employers also should understand what coverage options would preserve employees’ in-network access to Sanford providers and facilities in 2027.
Questions about your care
How do I know if I might be affected?
You may be affected if you have insurance coverage through Wellmark or use BlueCard coverage to receive care at Sanford Health locations in South Dakota or Iowa. For questions about your specific benefits, contact your insurance company using the member services number on your insurance card.
Can I still receive care at Sanford?
Yes. Sanford remains in network with Wellmark until July 1, 2027, and patients can continue receiving care from Sanford physicians, advanced practice providers, hospitals and clinics just as they do today.
Do I need to do anything right now?
You should continue scheduling appointments and receiving care as usual. However, we encourage you to understand your coverage and available options now so you can make informed decisions if Sanford’s contract with Wellmark ends July 1, 2027.
If you receive insurance through an employer or insurance broker, ask about your coverage options for 2027 and whether your preferred Sanford physicians, hospitals and clinics will be in network. If you purchase coverage through the Health Insurance Marketplace, carefully review each plan’s provider network, benefits and out-of-pocket costs.
Will my scheduled appointments be canceled?
No. Scheduled appointments, procedures and treatments will continue as planned.
Should I look for a new provider?
No. There is no reason to change providers or your care plans at this time. Sanford remains in network with Wellmark, and patients should continue receiving care as usual.
Has my insurance coverage changed?
No. This notice does not change your coverage, benefits, provider network or access to care today.
Will my deductible, copay or coinsurance change?
No changes are occurring at this time. Questions about your specific benefit plan should be directed to Wellmark using the member services number on your insurance card.
Will my prescriptions be affected?
No. There are no changes to prescription drug coverage today as a result of these negotiations.
What should I consider during open enrollment?
Carefully review each plan’s provider network, benefits and out-of-pocket costs. Confirm that your preferred physicians, hospitals and clinics participate in the network of any plan you are considering.
If you receive insurance through an employer or insurance broker, ask about the coverage options available to you for 2027. If you purchase insurance through the Health Insurance Marketplace, compare available plans and confirm whether your Sanford providers and facilities will be in network.
When would Sanford go out of network with Wellmark if an agreement is not reached?
Sanford remains in network with Wellmark today. If the organizations are unable to reach an agreement, the current termination notice would take effect July 1, 2027. Sanford and Wellmark may continue negotiating throughout the notice period, and Sanford's goal remains reaching an agreement before that date.
Is this related to Wellmark's exit from the Medicare Advantage market?
No. Wellmark's planned exit from the Medicare Advantage market in our region, effective Jan. 1, 2027, is a separate business decision by Wellmark and is not related to these negotiations. This contract notice involves Sanford's commercial contracts with Wellmark.
Is Sanford trying to leave Wellmark's network?
No. Sanford's preference is to reach a fair, sustainable agreement that provides stability, certainty and reliable access to care. That includes market-appropriate reimbursement rates and predictable contract terms. Decisions that could affect patient care, access and the healthcare services available in our communities should be negotiated by both organizations, not controlled by an insurance company alone.
If Sanford becomes out of network for Wellmark, can I still receive care from my Sanford provider?
Yes. Patients with Wellmark coverage would still be able to receive care from Sanford physicians, advanced practice providers, hospitals and clinics. Sanford will continue caring for patients regardless of the outcome of the negotiations. Coverage and out-of-pocket costs would depend on the specific terms of a patient's health plan.
Why couldn't Sanford and Wellmark reach an agreement?
The negotiation is about more than rates. Wellmark is demanding a long-term contract that gives them the sole authority to change provider payments, many reimbursement methodologies and other key contract provisions affecting patient care and healthcare delivery without mutual agreement. Sanford also believes a sustainable agreement must include market-appropriate reimbursement rates and predictable contract terms that support continued access to local healthcare services. Sanford believes significant changes should be negotiated and agreed upon by both organizations.
Why is Sanford concerned about the proposed contract?
Sanford is concerned about Wellmark’s continued sole authority to change important contract terms after an agreement is signed, including terms affecting patient care and access.
In our experience, other payer relationships operate through negotiation and mutual agreement when substantive contract changes are proposed. Wellmark has a history of exercising broad control to change terms in a way that materially affects providers, patient care and agreed upon reimbursement. Similar practices have drawn concerns from hospital associations and policymakers in several states, with some states enacting legislation to prohibit them. Iowa just passed legislation in 2026 focused on addressing Wellmark’s specific practices.
Sanford believes patients deserve healthcare agreements that provide stability, accountability and protections that remain in place throughout the life of the agreement. Patients are best served when decisions affecting their care are made collaboratively by healthcare providers and insurers.
What is Sanford seeking in an agreement?
Sanford is seeking a fair, sustainable agreement that:
- Protects patients’ access to high-quality care.
- Preserves local healthcare services in urban and rural communities.
- Provides stable and market-appropriate reimbursement for the care patients receive.
- Ensures significant contract changes are negotiated and agreed upon by both organizations.
- Provides stability, certainty and accountability throughout the life of the agreement.
How could these negotiations affect rural communities?
Rural communities depend on local hospitals, clinics, physicians, emergency care and specialty services close to home. Sustaining those services requires stability, long-term planning and continued investment in the workforce, facilities and programs patients rely on.
When healthcare providers face uncertainty about reimbursement or what contract terms may change, it becomes more difficult to plan for the services communities need. That uncertainty can make it harder to sustain local healthcare services, 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.
What happens next?
Sanford and Wellmark may continue negotiating during the notice period. Our goal remains reaching an agreement before the contract termination date. We will share updates on this page as they become available.
What happens if an agreement is not reached?
If Sanford and Wellmark do not reach an agreement, Sanford would become out of network with Wellmark on July 1, 2027. Patients with Wellmark coverage could still receive care from Sanford providers and facilities, but their coverage and out-of-pocket costs would be determined by their specific plan’s out-of-network benefits.
For now, Sanford remains in network with Wellmark. Patients should continue scheduling appointments and receiving care as usual while reviewing their coverage and available options for 2027.
Will my healthcare costs increase if Sanford becomes out of network?
There are no changes to your healthcare costs, coverage or benefits today. If Sanford becomes out of network with Wellmark after July 1, 2027, coverage and out-of-pocket costs would depend on your specific Wellmark plan.
Contact your insurance company using the member services number on your insurance card for information about your benefits and possible out-of-network costs.
Are Lewis Drug locations and Good Samaritan facilities affected?
No. Lewis Drug locations and Good Samaritan facilities are not affected by this contract termination notice.
Who should I contact with questions about my benefits?
Contact your insurance company using the member services number on your insurance card. Your insurance company can answer questions about your specific coverage, provider network, benefits and possible out-of-network costs.
Who do I contact for media inquiries?
Please reach out to Sanford media relations by contacting Paul Heinert, director, media relations at paul.heinert@sanfordhealth.org.
Employer FAQs
This section is for employer groups in South Dakota and Iowa whose employees have insurance coverage through Wellmark or who access care through the BlueCard PPO network.
How could our employees be affected?
There are no immediate changes to employees’ coverage, benefits, provider access or scheduled care. Employees should continue scheduling appointments and receiving care as usual.
If an agreement is not reached, employees with Wellmark coverage who receive care from Sanford providers and facilities may be affected after July 1, 2027. Employees using BlueCard coverage to receive care at Sanford locations in South Dakota or Iowa also may be affected, depending on their plan and where they receive care.
Employers should contact Wellmark for information about the provider network and benefits associated with their specific plan.
What should employers do now?
Employers should:
- Review their current Wellmark plan and provider network.
- Discuss the potential impact with Wellmark and their benefits consultant, broker or adviser.
- Ask what out-of-network coverage and cost-sharing provisions apply to their plan.
- Understand what options would preserve employees’ in-network access to Sanford providers and facilities in 2027.
- Share accurate information with employees while avoiding speculation about the outcome of negotiations.
Employers do not need to direct employees to change providers or interrupt their care today.
Is Sanford asking employers to change health plans?
Sanford is not recommending a specific insurance carrier or plan. Coverage decisions belong to each employer based on the needs of its workforce.
Sanford is encouraging employers to understand the potential impacts if the Wellmark contract ends and evaluate what coverage options would preserve employees’ in-network access to the providers and facilities they depend on.
What should employers ask Wellmark or their benefits adviser?
Employers may want to ask:
- How would employees’ access to Sanford be affected if the contract ends?
- What out-of-network benefits and cost-sharing requirements apply to our plan?
- What transition-of-care protections would be available?
- What options would maintain employees’ in-network access to Sanford in 2027?
- How will Wellmark communicate with employers and members as negotiations continue?
What should we tell employees?
Employees should continue scheduling appointments and receiving care as usual. Sanford remains in network with Wellmark through July 1, 2027, and there are no immediate changes to coverage, benefits, providers or scheduled care.
Employees should also review their coverage and available options so they can make informed decisions if the contract ends July 1, 2027. Questions about individual benefits, provider networks or possible out-of-network costs should be directed to Wellmark using the member services number on the employee’s insurance card.
Additional information for employees is available in the “Questions about your care and coverage” section on this page.
Why does this matter to employers?
Employees may rely on Sanford for local, specialized, emergency or ongoing care. A network change could affect where employees receive in-network care and could require some employees to travel farther, take additional time away from work or make new arrangements for transportation and childcare.
Employers should consider affordable coverage and reliable access to care together when evaluating their 2027 options.
Who can I contact for more information?
Please reach out to us at coveragequestions-sh@sanfordhealth.org.