As emergency physicians, my husband and I were determined to protect ourselves, our teenagers, and society at-large with the latest, monovalent COVID vaccine, which the CDC recently recommended for every American 6 months and older.

I realized, though, we were in for turbulence when my 78-year-old mother arrived for her appointment at a national pharmacy chain only to be told they did not yet have the vaccine. When Mom asked why she had been able to secure an appointment online, the tech suggested she call national headquarters for an answer.

So, while I expected some difficulty when I reserved our family’s vaccine appointments, I did not foresee the magnitude of the rabbit hole I was going to go down.

Early in the pandemic, the COVID vaccine was free for any American. Congress passed several bills requiring both public and private insurers to cover the shot fully to improve patient access, encourage the public to get immunized, and facilitate equitable distribution. (As we know, those goals were not wholly met.) Many of these requirements, however, were tied to the public health emergency declared in January 2020 and renewed until May 11, 2023. Even after the Biden administration terminated the emergency, Americans were still able to access the vaccine at no cost, facilitating continued protection of the public through immunization. This access was based on the CDC COVID-19 Vaccination Program Provider Agreement, a policy that ended this month, leaving the acquisition and provision of the new monovalent vaccine in the commercial marketplace. Once Congress did not provide more funds for the federal government to buy the vaccine – and do so at bulk prices – the cost rose and was shifted to health insurance companies.

While it is currently difficult to assess accurate COVID case numbers, in part because of the ubiquitous use of at-home tests – if individuals test at all – U.S. COVID wastewater numbers are up. With cases higher, and in light of the CDC’s recent universal recommendation, our collective goal should be to clear how Americans get the new monovalent vaccine.

In my family’s case, despite having PPO health insurance, our pharmacy benefits plan was not covering the vaccine, but our medical plan was. To be clear, each health insurance company utilizes a separate drug plan and medical benefits plan. The former covers medications prescribed through and delivered at a pharmacy; the latter, services at a doctor’s office, urgent care, or hospital.

This distinction is where the odyssey for my family began: No sources in the medical plan were offering the COVID shot. I called our pediatrician, primary care doctor, private and community clinics, urgent care, pharmacy-based medi-clinics – and not a single one was offering the vaccine.

We were facing a Catch-22: My family was covered for the COVID shot at any in-network medical clinic, but not one offered the vaccine. We were not covered at any pharmacy – but only pharmacies had the shot.

I had the time and language capabilities to do a comprehensive search, and still came up dry. Many other Americans do not have the resources to do this digging.

With COVID numbers up and an extended family member suffering with a severe illness, we decided to pay out-of-pocket for the vaccine. Even the sympathetic 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 their credit, will be offering the COVID vaccine free to hospital staff and volunteers, so he will soon obtain it there. Had he not been able to get immunized for free at work, we would have paid $764 to get our family vaccinated – with PPO insurance.

While, in theory, everyone with health insurance should be able to access the new COVID vaccine, we are not the only people describing barriers. The California Medical Association reports that some patients are facing unexpected coverage denials because their insurance companies did not update the new vaccine’s billing codes, even though these codes were released over a month ago.

As we enter the winter months, let our experience navigating our very broken health care system – as physicians – serve as a warning. While health insurance companies should be covering the vaccine, some are falling short. Those of us who assume our health insurance will take care of the cost of the COVID shot may face enormous out-of-pocket expenses while attempting to comply with public health recommendations.

This essay is cited in the KevinMD record on COVID-19.

Michelle Finkel is a physician and founder of an advising company.