Fighting Medical Debt in South Dakota
I got a medical bill I can't afford — here's what South Dakota law says and what to do next.
Statute: S.D. Codified Laws § 37-24 (South Dakota Deceptive Trade Practices Act)
Deadline: 120 days
Penalty: violations of South Dakota's Deceptive Trade Practices Act may result in actual damages, civil penalties, and attorney fees
What is fighting medical debt?
Medical debt is the leading cause of bankruptcy in the United States, affecting an estimated 100 million Americans. Recent federal actions have significantly strengthened your rights when dealing with medical debt — including new rules removing most medical debt from credit reports and protections against surprise billing.
The No Surprises Act (effective January 2022) protects you from unexpected bills when you receive emergency care or are treated by an out-of-network provider at an in-network facility without your consent. Additionally, the three major credit bureaus voluntarily removed medical debt under $500 from credit reports in 2023, and the CFPB finalized a rule in January 2025 to remove all medical debt from credit reports, but a federal court vacated that rule in July 2025 (Cornerstone Credit Union League v. CFPB) before it took effect.
What to Do If You Get a Medical Bill You Can't Afford
Step 1: Request an itemized bill. Medical billing errors are extremely common — studies suggest up to 80% of medical bills contain errors. Compare the itemized bill against your insurance Explanation of Benefits (EOB).
Step 2: If you received a surprise bill (out-of-network charges you didn't consent to), file a complaint under the No Surprises Act. Contact your insurer, the provider, and CMS at 1-800-985-3059. You should only owe your in-network cost-sharing amount.
Step 3: Ask the hospital about financial assistance. If the hospital is a nonprofit (most are), they must have a financial assistance policy. Request the application — you may qualify for free or reduced-cost care even with insurance.
Step 4: Negotiate the bill. Hospitals regularly accept less than the full amount. Ask for a reduction, a payment plan with no interest, or offer a lump-sum settlement for a lower amount. Get any agreement in writing.
Step 5: If the debt goes to collections, know your FDCPA rights. Request debt validation in writing within 30 days. Medical debt collectors must follow the same rules as any other debt collector. If the debt is on your credit report, check whether it qualifies for removal under the new credit reporting rules.
How South Dakota differs from federal law
South Dakota provides some debtor protections for individuals with medical debt, highlighted by its unlimited homestead exemption:
- Unlimited homestead exemption (SDCL § 43-45-3): South Dakota's unlimited value homestead exemption (up to 1 acre in a city) protects your primary residence from medical debt judgments regardless of how much the home is worth. This is one of the strongest homestead protections in the nation.
- Wage garnishment: South Dakota follows the federal wage garnishment limit of 25% of disposable earnings or the amount exceeding 30x the federal minimum wage, whichever is less.
- Statute of limitations: The statute of limitations on medical debt (contract claims) in South Dakota is 6 years (SDCL § 15-2-13). After 6 years, creditors cannot sue to collect the debt.
- No Medicaid expansion: South Dakota has not expanded Medicaid under the ACA (voters approved expansion via ballot measure in 2022, and it became effective July 2023). This expansion provides coverage to adults earning up to 138% of the federal poverty level, reducing medical debt exposure.
- Indian Health Service: South Dakota has a significant Native American population served by the Indian Health Service (IHS). IHS-eligible patients generally are not billed for services received at IHS facilities.
- No Surprises Act: The federal No Surprises Act protects South Dakota patients from surprise out-of-network billing for emergency services and at in-network facilities.
Additional steps in South Dakota
Request an itemized bill and dispute any errors in writing. Ask about charity care or financial assistance programs. File complaints with the South Dakota Attorney General at (605) 773-4400. Dakota Plains Legal Services: 1-800-658-2297. East River Legal Services: 1-800-952-3015.
What you should NOT do
Don't pay a bill you haven't verified. Always request an itemized bill and compare it to your insurance EOB before paying. Errors are extremely common.
Don't put medical debt on a credit card. Medical debt has special protections (lower interest, financial assistance eligibility, credit reporting limits) that you lose once you transfer it to a credit card.
Don't ignore the bill entirely. While medical debt protections are expanding, ignoring bills can lead to lawsuits, wage garnishment, and damage to your credit that could have been avoided through negotiation or financial assistance.
Don't assume you don't qualify for financial assistance. Income thresholds for hospital charity care programs are often surprisingly high (200-400% of the federal poverty level). Apply even if you think your income is too high.
You shouldn't have to hire a lawyer to assert your rights.
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Generate your medical bill dispute →This page is general legal information for South Dakota, not legal advice for your specific situation. Laws change, and how a statute applies depends on facts we don't know. For advice on your matter, consult a licensed attorney in South Dakota.