This report responds to a requirement in Executive Order 13877, "Improving Price and Quality Transparency in American Healthcare to Put Patients First." It describes the phenomenon of a "surprise billing," particularly in the commercial insurance market, the underlying federal and state regulatory frameworks, and recent state actions to address the problem. It also describes federal actions to encourage price transparency for medical services. It summarizes pending federal legislation and describes what congress and the Department have done to address surprise billing during the COVID-19 Public Health Emergency. The report explains why federal legislation is needed to address surprise billing and asserts that the time is right for such action.