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Illustration: Sarah Grillo/Axios

At least one major source of tension remains unresolved regarding the new law banning surprise medical bills: what it looks like for patients to willingly waive their protections — or refuse to waive them.

Why it matters: This could yet again pit providers' rights against their patients'.

Driving the news: The Biden administration last week released the first rule implementing the surprise billing law passed late last year, which will take effect in January.

  • It asked for input on several issues, including how to handle non-emergency situations in which a patient seeks care from a provider who isn't covered by their insurance.
  • "HHS seeks comment on striking the appropriate balance between allowing a specialist to refuse to treat an individual unless the specialist can balance bill the individual while ensuring that the individual is not being pressured into waiving the balance billing protections," the rule states.

Between the lines: The law allows providers to bill patients for out-of-network care in certain situations only after a stringent "notice and consent" process.

  • However, "consent" can be a tricky concept. The law — and the rule — is clear that patients shouldn't feel coerced into signing away their surprise billing protections.
  • But the administration appears to be suggesting that it's not clear what rights a provider, particularly a specialist, has to refuse care if the patient won't sign the consent form.
  • If providers don't have the option to refuse to treat out-of-network patients who won't consent to being billed as such, it could undermine the entire concept of insurance networks.

What they're saying: “This was always designed to preserve patient choice, not to become a massive loophole for surprise billing," said Adam Buckalew, founder of ALB Solutions and a former congressional aide who helped write the surprise billing law.

  • "The rule seeks clarity on maintaining balance for both patients and specialists in limited scenarios," he told Axios.

Go deeper

Florida lawmaker introduces abortion bill modeled after Texas law

A view of the old Florida Capitol building, which sits in front of the current Capitol building, in Tallahassee. Photo: Mark Wallheiser/Getty Images

A Florida lawmaker introduced a bill Wednesday modeled after Texas' new law prohibiting abortions after a fetal heartbeat is detected, or roughly six weeks — before many people know they are pregnant.

Why it matters: Similar bills introduced to the Florida legislature have failed, but that was before the Supreme Court declined to block Texas' law, which is the most restrictive abortion law to be enforced since the Supreme Court's Roe v. Wade decision legalized abortion nationwide in 1973, according to AP.

Updated 14 hours ago - Technology

From Malcolm X to "Free Britney," new media shapes the justice system

Illustration: Shoshana Gordon/Axios

True crime documentaries, podcasts and social media campaigns are bringing new attention to real-world legal proceedings — and are often affecting the outcome.

Why it matters: New media platforms can instantly put a national spotlight on cases that have long been forgotten or buried under red tape.

Updated 16 hours ago - Health

The next big bottleneck in the global vaccination effort

Illustration: Rae Cook/Axios

The world still needs more coronavirus vaccines, but an additional bottleneck has emerged in many low-income countries: They need help getting shots in arms.

Why it matters: Increasing vaccination rates across the world is both a humanitarian necessity and the best way to prevent dangerous new variants from emerging, but it increasingly requires complex problem-solving.

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