She Needed an EpiPen. But First, an Urgent Care Asked Her To Pay.

The Billing Problem: Emergency Care or Urgent Care?

Rowell said she was stunned that she was expected to pay before she received the shot of epinephrine. She returned to the waiting area to retrieve her wallet from her dad.

After she handed over her debit card, she said, the medical assistant gave her the shot. Within a few minutes, she could feel her throat loosening and her symptoms eased.

“I asked, ‘If I didn’t have the money, would you have just let me die?’” Rowell said. “And they said, sorry, that is their policy.”

Rowell says her body started itching all over and her face became swollen and red after she was stung by a wasp at her parents’ home. “I thought I was going to die,” she says. (Eric Harkleroad/KFF Health News)

Officials at TruHealthNow, which privately owns and operates eight urgent care centers in Northern Virginia and Maryland, said Rowell was told its policy in emergencies is to first provide treatment before handling billing. “Our policy is we give the shot and worry about the money later,” Preet Takhar, TruHealthNow’s CEO, said in an interview with KFF Health News.

The company officials confirmed Rowell was asked to pay before she received the shot. They said the nurse practitioner first determined Rowell’s condition was stable and that she was asked for payment as the injection was being prepared.

The request for payment did not delay administering the shot, said Manbir Takhar, who is married to Preet Takhar.

“The patient was stable, and that is why we took the payment then,” she said.

Federal law requires hospital emergency departments to stabilize anyone who shows up, regardless of ability to pay. But urgent care centers generally don’t fall under that law unless they are owned by hospitals, said Barry Furrow, director of the health law program at Drexel University in Philadelphia.

Urgent care centers have proliferated across the country in recent years, offering quick access to care, especially for people who don’t have a regular physician or can’t immediately see one, and particularly after hours and on weekends. The clinics usually take insurance and charge patients who don’t have coverage.

More than 15,000 urgent care centers handled about 185 million patient visits in 2025, according to the Urgent Care Association, a national trade group.

Urgent care centers offer a wide range of primary care services, treating conditions such as sore throats, flu, sprained ankles, and minor cuts. While services vary, they are not intended to treat life-threatening emergencies such as heart attacks or traumatic injuries.

Rowell’s father was driving her to an emergency room when they spotted the TruHealthNow urgent care clinic in Purcellville, Virginia. They decided to stop, hoping she would get help faster for her allergic reaction to a wasp sting. (Eric Harkleroad/KFF Health News)

Yet people sometimes show up at urgent care centers when they need emergency care, usually because they do not realize the seriousness of their condition, said Alan Ayers, an urgent care industry consultant.

While urgent care centers, like most doctors’ offices, ask for an insurance card or payment up front, that should not happen for patients needing emergency help, he said.

“Collecting a copay at check-in is standard across outpatient medicine, and it’s a separate question,” Ayers said. “For a sore throat, it doesn’t matter much. For anaphylaxis, it should never come up.”

Doctors also face an ethical obligation to treat patients facing an emergency if they have the capability, without asking for up-front payment, said Arthur Caplan, professor emeritus and past head of the medical ethics division at the New York University Grossman School of Medicine.

In a lifesaving situation, “you don’t need to have a patient go fumbling around for a credit or insurance card,” he said. “If you have the skill to take care of someone, you should.”

Medical experts say patients should generally know when to seek care at a hospital instead of an urgent care facility. For example, if they have trouble breathing or are experiencing chest pain, they should head to the ER. But some cases are not as clear-cut.

“Patients do not always know the severity of their condition when they decide where to go for care, and a patient’s condition can change,” said Steven Sellars, CEO of the Urgent Care Association.

Sellars said urgent care operators establish their own policies for what to do when patients need emergency care, such as when to transfer patients to a hospital.

The Resolution

Rowell went home after leaving the urgent care center. Her brother stayed with her to watch her for complications. “I felt wiped out,” she said, noting it took several days until she felt completely better.

Her daughter posted a summary of her experience on a Facebook community group’s page, eliciting hundreds of comments.

Rowell said she wasn’t upset at the price but believed she shouldn’t have had to pay before receiving the epinephrine. The price for a generic EpiPen is about $175, according to GoodRx.

She said she now carries an EpiPen.

Rowell now carries an epinephrine auto-injector after she experienced a severe allergic reaction to a wasp sting. (Eric Harkleroad/KFF Health News)

The Takeaway

When in doubt as to whether you are having a medical emergency, always err on side of caution and go to the nearest ER or call 911, said Ryan Stanton, president of the American College of Emergency Physicians.

People with life-threatening allergies should get a prescription for an EpiPen to keep at home or with them, said Stanton, who is an ER physician in Lexington, Kentucky.

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!