We received the new COVID vaccine. It was a whopping $191 per shot.

As emergency physicians, my husband and I were determined to protect ourselves, our teens, and society as a whole with the latest monovalent COVID vaccine, which the CDC recently recommended for all Americans aged 6 months and more.

I realized we were in for some turmoil, however, when my 78-year-old mother arrived for her appointment at a national pharmacy chain to be told she didn’t have the vaccine yet. When Mom asked why she was able to get an appointment online, the technician suggested she call national headquarters for an answer.

So while I expected some difficulty when I booked our family’s vaccination appointments, I didn’t anticipate the depth of the rabbit hole I was about to descend into.

At the start of the pandemic, the COVID vaccine was free for all Americans. Congress has passed several bills requiring public and private insurers to fully cover the vaccine to improve patient access, encourage the public to get vaccinated, and facilitate equitable distribution. (As we know, these goals were not fully achieved.) Many of these requirements, however, were related to the public health emergency declared in January 2020 and renewed until May 11, 2023. Even after the administration Biden ended the emergency, Americans were still able to access the vaccine for free, making it easier to continue protecting the public through vaccination. This access was based on the CDC’s COVID-19 Vaccination Program Provider Agreement, a policy that ended this month, leaving the acquisition and supply of the new monovalent vaccine to the commercial market. Once Congress failed to provide more funds to the federal government to purchase the vaccine — and do so at wholesale prices — the cost increased and was shifted to health insurance companies.

Although it is currently difficult to accurately gauge the number of COVID cases, in part because of the ubiquitous use of at-home testing – if individuals get tested – the COVID sewage numbers in the United States- United are on the rise. With cases increasing and in light of the CDC’s recent universal recommendation, our collective goal should be to clarify how Americans obtain the new monovalent vaccine.

In my family’s case, despite having PPO health insurance, our pharmacy plan did not cover the vaccine, but our medical plan did. To be clear, each health insurance company uses a separate drug plan and medical insurance plan. The first covers medicines prescribed and delivered in pharmacies; the latter, the services of a doctor’s office, urgent care or hospital.

It was from this distinction that my family’s odyssey began: no medical plan source offered the COVID vaccine. I called our pediatrician, our primary care physician, our private and community clinics, our urgent care, our pharmacy medical clinics – and not a single one offered the vaccine.

We were faced with an impasse: My family was covered for the COVID vaccine at any in-network medical clinic, but none offered the vaccine. We were not covered at any pharmacy – but only pharmacies were vaccinated.

I had the time and language skills to do a full search, but I still didn’t succeed. Many other Americans do not have the resources to undertake this research.

With the number of COVID cases increasing and an extended family member suffering from a serious illness, we decided to pay out of pocket for the vaccine. Even the friendly pharmacist at CVS was shocked by the price: The COVID vaccine would cost a total of $573 for our two teenagers and me. My husband’s workplace, to his credit, will be offering the COVID vaccine for free to hospital staff and volunteers, so he will get it there soon. If he hadn’t been able to get a free vaccine at work, we would have paid $764 to get our family vaccinated – with PPO insurance.

Although, in theory, anyone with health insurance should be able to access the new COVID vaccine, we are not alone in describing barriers. The California Medical Association reports that some patients are facing unexpected coverage denials because their insurance companies have not updated the new vaccine. vaccine billing codes, even if those codes were published more than a month ago.

As we enter the winter months, let our experience navigating a very broken healthcare system – as physicians – serve as a warning. While health insurance companies should cover the vaccine, some fail to do so. Those of us who assume our health insurance will cover the cost of the COVID vaccine may face enormous out-of-pocket expenses while trying to comply with public health recommendations.

Michelle Finkel is a physician and founder of a consulting company.