Talk about adding insult to injury.
A Virginia woman in the throes of a life-threatening allergic reaction was told to cough up hundreds of dollars before a nurse would administer an EpiPen.
“I asked, ‘If I didn’t have the money, would you have just let me die?’ ” Stephanie Rowell recalled in an interview with KFF Health News. “And they said, sorry, that is their policy.”
Like millions of Americans, Rowell, a manager at an agritourism business, doesn’t have health insurance.
The 53-year-old has been without coverage since 2025, when she said she could no longer afford to buy a policy on her own.
The harsh reality of going without protection hit home in July, when a wasp sting at her parents’ house triggered a terrifying cascade of symptoms.
Suddenly, Rowell’s arm felt like it was “on fire.” Her body began to itch profusely while her face swelled and turned red.
She popped a Benadryl and jumped in the car with her father, heading for the nearest emergency room, about 25 minutes away.
But just 10 minutes into the drive, her throat began to tighten. Realizing she couldn’t wait, the pair pulled into a nearby TruHealthNow urgent care center in hopes of getting her treated faster.
Once inside, she told staff she didn’t have health insurance. A nurse practitioner examined her and diagnosed her with anaphylaxis.
The severe, potentially deadly reaction can set in within seconds or minutes of exposure to an allergen, according to the Mayo Clinic.
When it happens, the immune system unleashes a flood of chemicals that can cause blood pressure to plummet and airways to swell, making it difficult — or even impossible — to breathe.
The condition is considered a medical emergency that requires an immediate injection of epinephrine, the medication used in EpiPens, to counteract the reaction and help restore normal breathing.
An estimated 1 to 5 in every 100 Americans have experienced anaphylaxis, which claims about 225 lives each year, according to the Allergy & Asthma Network.
But even after Rowell was diagnosed, she said a medical assistant asked her to pay $400 before the clinic would give her the potentially lifesaving injection.
Stunned, she went to the waiting area to grab her debit card. After receiving the shot, she said, her throat began to loosen and her symptoms quickly eased.
“I thought I was going to die,” Rowell said.
Officials at TruHealthNow, which privately owns and operates eight urgent care centers in Northern Virginia and Maryland, confirmed to KFF Health News that Rowell was asked to pay before staff administered the EpiPen.
But the company’s CEO, Preet Takhar, told the outlet that its policy is to “give the shot and worry about the money later.”
The company maintained that staff had first determined Rowell’s condition was stable and that the payment request came while the injection was being prepared.
“The patient was stable, and that is why we took the payment then,” Manbir Takhar, who is married to Preet Takhar, told KFF Health News, denying that the request for payment delayed Rowell’s treatment.
Federal law generally requires hospital emergency departments to stabilize patients regardless of their ability to pay, but that protection doesn’t necessarily extend to urgent care clinics.
Most aren’t covered by the law unless they’re hospital-owned, according to Barry Furrow, director of the health law program at Drexel University in Philadelphia.
And while urgent care centers offer a range of medical services, they’re not designed to handle life-threatening emergencies — even though patients sometimes turn to them in a crisis.
After receiving the injection, Rowell was monitored by a medical assistant for about 30 minutes before being sent home. Her brother stayed with her to watch for any complications.
“I felt wiped out,” she said, noting that it took several days before she felt completely better.
The frightening ordeal ultimately cost Rowell $605: $400 for the medication, a $40 administration fee and $165 for the urgent care visit.
She said she wasn’t upset about the price itself, but believed she should never have been asked to pay before receiving the epinephrine. She now carries an EpiPen of her own.
News about Rowell’s experience comes as millions of Americans face growing uncertainty over their ability to afford health care.
The number of uninsured working-age adults in the US climbed to 11.2% this year, up from 8.9% in 2024, according to an October analysis by the Commonwealth Fund, a health policy and philanthropic nonprofit.
The increase comes after Congress allowed enhanced federal subsidies that made Obamacare plans more affordable during the pandemic to expire at the end of 2025.
The group’s biennial survey of 7,362 working-age adults found that 46% were uninsured, underinsured or had experienced a gap in their coverage in 2026.
Half said they had delayed or skipped medical care because of the cost, up from 46% in 2022.
And the problem is only expected to grow.
The Commonwealth Fund estimates that 37 million Americans will be uninsured by 2036, roughly the same number as in 2014, when the Affordable Care Act’s changes took effect.
