The No Surprises Act, passed by Congress at the end of 2020, offers significant protections to most Americans with private health insurance. Insured Americans are vulnerable to receiving surprise medical bills when they receive services from out-of-network providers. Protections for consumers against such bills initially emerged in several states that passed laws. The varying approaches taken in different state laws ultimately offered a foundation for federal legislation. Although there was always a broad consensus among stakeholders for protecting consumers during both state and federal deliberations, it was a challenge to identify a means of determining the amount that an insurer should pay to the out-of-network provider. But the Congress eventually reached a compromise that became law, which goes into effect in January 2022.