Stephanie Rowell was on her parents’ porch in Virginia when a wasp sting triggered a severe allergic reaction. Within minutes, her arm burned, her throat tightened, and her face swelled. Her father spotted TruHealthNow, an urgent care center in Purcellville, 10 minutes into their drive and took her there. “I thought I was going to die,” Rowell recalled.
Rowell, 53 and uninsured since 2025, arrived with symptoms of anaphylaxis—a life-threatening allergic reaction. A nurse practitioner diagnosed the condition and ordered epinephrine, the standard treatment to prevent anaphylactic shock. But before the shot could be given, a medical assistant demanded $400 up front. Rowell, who runs an agritourism business, paid with her debit card.
The injection was administered shortly after, easing her symptoms within minutes. When she asked what would happen if she couldn’t pay, the assistant replied: “And they said, sorry, that is their policy.” 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.
TruHealthNow operates eight urgent care centers in Northern Virginia and Maryland. However, Rowell was asked for payment while the injection was being prepared, according to the clinic’s medical director, Manbir Takhar. The company confirmed its official policy is to treat first, then bill later in emergencies. The company stated her condition was stable at the time of the request.
Federal law requires hospital emergency departments to stabilize patients regardless of payment ability. Urgent care centers, however, are not bound by the same rules unless they are hospital-owned. The industry handled over 185 million visits in 2025, but policies on emergency treatment vary widely. Medical experts argue that up-front payment requests for life-threatening conditions are unethical. Arthur Caplan, a medical ethics professor at NYU, stated that in emergencies, “you don’t need to have a patient go fumbling around for a credit or insurance card.”
How urgent care policies leave patients vulnerable
Rowell’s experience reveals inconsistencies in urgent care policies. While clinics treat minor conditions like sore throats or sprains, some patients arrive needing emergency care without realizing the severity of their symptoms. After receiving treatment, Rowell was monitored for 30 minutes, a standard precaution given the risk of recurrent anaphylactic reactions.
Rowell later posted about the incident on Facebook, sparking hundreds of comments. Though she wasn’t upset about the price, she now carries an EpiPen, she questioned the policy of demanding payment before treatment. Generic EpiPens cost around $175, according to GoodRx, far below the $400 charged at TruHealthNow.
Rowell’s case is one of many documented by KFF Health News and The Washington Post’s Bill of the Month series, which investigates confusing or excessive medical bills. The series has influenced policy discussions at state and federal levels.
Ethics vs. profit: Contradictions in emergency billing
The medical assistant’s demand for up-front payment for epinephrine contradicts ethical guidelines for emergency care. While TruHealthNow’s CEO, Preet Takhar, insisted the company’s formal policy is to treat first and bill later, Rowell’s account and internal statements confirm she was asked for payment during the preparation of the injection.
Following the epinephrine injection, Rowell’s vital signs were continuously checked by clinic staff. Manbir Takhar confirmed a medical assistant monitored her for 30 minutes post-treatment, aligning with clinical recommendations for stable cases. The clinic’s total bill of $605, $400 for the medication, $40 for administration, and $165 for the visit, far exceeds the $175 cost of a generic EpiPen.
