South Dakota: Start Here
Beginner guide for South Dakota—HealthCare.gov, Division of Insurance external review, SDCL 58-17H/I PA & appeals.
Read guideState playbook
South Dakota
State insurers, legislation, and appeal resources for patients and advocates in South Dakota.
4 guides
South Dakota Prior Authorization Law
SDCL 58-17H & SB 155—step therapy 5-day/72-hour; HB 1199 PA reporting; no gold card law.
Read guideSouth Dakota Health Insurance Appeals and Grievances
SDCL 58-17I—180-day filing, 30-day deemed exhaustion, path to Division-assigned IRO.
Read guideSouth Dakota External Review (Division of Insurance / IRO)
Binding on carrier—4 months to file with Division, 45-day IRO decision; call for expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Avera Health Plans
- Sanford Health Plan
- Wellmark Blue Cross Blue Shield of South Dakota
- HealthCare.gov (South Dakota)
- South Dakota Medicaid
External appeals
After internal appeal, for eligible South Dakota fully insured plans only.
- Division of Insurance — external review
- Medicaid — fair hearing