Innovative Health Care: A Look at Coverage and Litigation

• April 28, 2021

• Mackenzie Wallace , Thompson Coburn LLP
• Jennifer Ecklund , Thompson Coburn LLP
• Elise Puma , Thompson Coburn LLP

Innovation in health care faces a number of significant hurdles, from funding research to licensure requirements. One obvious, but less recognized constraint is the impact of nonpayment or oppressive reimbursement policies on innovation. When payers refuse to reimburse providers, or reimburse at low rates, for innovative care, providers are less willing and able to provide new approaches to medical treatment.

Payers face challenges in delivering affordable health care coverage while ensuring access to medical innovation. Payers have in some cases attempted to limit their costs by denying claims for treatments that could advance access to care, citing the location of services, types of services, and which providers may administer services as the cause for denial. Recent trends in regulatory changes and litigation may curb these limits, however, and continue to foster alternative approaches to treatment. The impact of COVID-19 on the ability of people to access care in non-traditional settings and unique ways may help lend credence to the worthiness of innovative health care delivery as well.

ARTICLE TAGS

• Health Care Liability and Litigation Practice Group
• Health Insurance