An urgent care asked an uninsured patient for $400 before an epinephrine shot
KFF Health News' latest Bill of the Month shows that urgent care centers, which generally fall outside the federal law requiring emergency departments to treat first, can ask for payment before treating a patient in anaphylaxis.
An urgent care center in Northern Virginia required an uninsured patient having a severe allergic reaction to pay $400 before it gave her an epinephrine shot, KFF Health News reported1 on October 29 in its Bill of the Month series. The full bill for the visit came to $605.
The case shows a gap in the rules on who must treat first and bill later. Federal law requires hospital emergency departments to stabilize anyone who arrives, whether or not they can pay. Urgent care centers generally are not covered by that law unless a hospital owns them, Barry Furrow, a health law professor at Drexel University, told KFF Health News.
More than 15,000 urgent care centers handled about 185 million patient visits in 2025, according to the Urgent Care Association, as cited by KFF Health News.
The patient had been uninsured since 2025, when she said she could no longer afford coverage on her own, according to the report. She was stung by a wasp in July and was on her way to an emergency room when she stopped at a TruHealthNow urgent care center in Purcellville, hoping for faster help.
After she said she had no insurance, a nurse practitioner diagnosed anaphylaxis and said she needed epinephrine, according to the report. A medical assistant told her she had to pay $400 up front, and she paid with her debit card before receiving the shot. Staff then monitored her for 30 minutes.
The bill broke down as $400 for the medication, a $40 fee for giving it and $165 for the visit. A generic EpiPen costs about $175, according to GoodRx, KFF Health News reported.
The patient told KFF Health News she was not upset about the price. Her objection was to being asked to pay before she was treated.
TruHealthNow, which owns and operates eight urgent care centers in Northern Virginia and Maryland, confirmed that she was asked to pay before receiving the shot. Its chief executive, Preet Takhar, said the company's policy in emergencies is to give the shot first and deal with payment later. Its medical director, Manbir Takhar, said the nurse practitioner had judged the patient to be stable, and that payment was requested while the injection was being prepared, without delaying it.
Others in the field questioned the practice. Alan Ayers, an urgent care industry consultant, said collecting copays is standard but that with anaphylaxis, payment "should never come up." Arthur Caplan, a medical ethicist at New York University, said clinicians have an ethical duty to treat emergencies without asking for payment first when they can.
Steven Sellars, chief executive of the Urgent Care Association, said patients do not always know how serious their condition is, and that each operator sets its own policy for emergencies.
The report did not say whether the bill was reduced or refunded, and it did not describe any complaint to regulators.
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