When 53-year-old Stephanie Rowell was stung by a wasp on her parents’ porch in Virginia, the reaction was immediate and frightening. Her arm felt like it was “on fire,” her body began itching, and her face became swollen and red. As her throat tightened and breathing became increasingly difficult, she feared for her life. Her father began driving her to the nearest emergency room, approximately 25 minutes away. After about 10 minutes, they spotted a TruHealthNow urgent care clinic in Purcellville and stopped, hoping she could receive treatment sooner. “I thought I was going to die,” Rowell recalled.
Rowell had taken Benadryl before leaving home, but antihistamines cannot treat the life-threatening breathing or cardiovascular symptoms of anaphylaxis. At the clinic, a nurse practitioner quickly diagnosed her with anaphylaxis—a severe, potentially fatal allergic reaction—and determined she needed an immediate injection of epinephrine. Rowell, who had been uninsured since 2025 because she could no longer afford coverage, expected prompt treatment. Instead, she encountered an unexpected demand: “The medical assistant apologized and said I had to pay $400 for the shot up front,” she told KFF Health News.
Stunned, Rowell returned to the waiting room to retrieve her wallet from her father. According to her account, the medical assistant administered the epinephrine only after she handed over her debit card. Within minutes, her throat began to loosen and her symptoms improved. Shaken by the experience, she confronted the staff. “I asked, ‘If I didn’t have the money, would you have just let me die?’” Rowell recalled. “And they said, sorry, that is their policy.”
Clinic leadership offered a different explanation. TruHealthNow CEO Preet Takhar insisted that the company’s policy is to provide emergency treatment before collecting payment. “Our policy is we give the shot and worry about the money later,” he said. However, clinic officials acknowledged that Rowell was asked to pay before receiving epinephrine. They maintained that the nurse practitioner had determined she was stable and that payment was collected while the injection was being prepared, causing no delay in treatment. According to medical director Manbir Takhar, staff also checked Rowell’s vital signs and monitored her for 30 minutes after administering the medication.
The incident exposes an important distinction between hospital emergency departments and standalone urgent care clinics. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), most hospital emergency departments must screen patients for emergency medical conditions and provide stabilizing treatment regardless of their insurance status or ability to pay. Most independent urgent care centers are not subject to the same federal requirements, although applicable state laws and professional obligations may still govern their care. While collecting payment before routine appointments is common, medical experts argue that financial considerations should never interfere with emergency treatment.
Urgent care consultant Alan Ayers emphasized that requesting payment during a life-threatening reaction is inappropriate. “For anaphylaxis, it should never come up,” he said. Arthur Caplan, professor emeritus of medical ethics at NYU Grossman School of Medicine, likewise stressed that healthcare providers have an ethical obligation to prioritize lifesaving care over billing procedures. Experts also noted that patients may not recognize how serious their symptoms are when deciding where to seek treatment, making appropriate emergency response procedures essential at urgent care facilities.
Rowell’s total bill came to $605: $400 for the epinephrine, a $40 administration fee, and $165 for the urgent care visit. She returned home after treatment, where her brother watched for complications, and reported feeling exhausted for several days. She now carries an epinephrine auto-injector. Although a generic EpiPen costs approximately $175 according to pricing cited by KFF, Rowell said her primary concern was not the amount charged but the requirement to pay before receiving lifesaving medication.
The experience serves as a reminder that anaphylaxis is a medical emergency in which every second matters. Epinephrine is the first-line treatment and should be administered immediately when anaphylaxis is suspected. People at risk should carry two doses of epinephrine at all times and know how to use them.
For Rowell, the question remains whether someone without immediate access to $400 would have received the same potentially lifesaving care.
