How often do health insurers say no to patients? (2023)

So far this year I'm seeing basically "We got $100 off! $0 paid by plan. You owe $xxx" I barely use it, but so far insurance isn't covering anything except basic $x refills

You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y.

Sometimes certain things are covered before you hit your deductible other times not.

Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20.

You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.

Unless you are comparing a generic to a name brand in a situation where the insurance company forces the name brand that shouldn't be the case.

For better or worse in your hypothetical the uninsured price legally has to be $1,000 for medicine. They can write off part of that but no one would write off 99.8% as the insurance company would sue their pants off.

> that shouldn't be the case

Oh, I agree. But it is.

> For better or worse in your hypothetical the uninsured price legally has to be $1,000 for medicine.

No, it doesn't.

https://www.nbcnews.com/health/health-news/cost-weight-loss-...

"In March, Novo Nordisk cut the price of all doses of Wegovy by 23% for people paying in cash, dropping it from $650 to $499 per month for uninsured patients or those without coverage. (The list price of $1,349 stayed the same.)"

"It follows a similar move from Eli Lilly, which reduced Zepbound’s starter dose to $349 and higher doses to $499 through its self-pay program, Lilly Direct. The discounted doses require patients to manually draw the medication from a vial with a syringe, adding an extra step compared to the prefilled injector pens."

There are entire businesses and apps built around figuring out which is cheaper, paying out of pocket or going through insurance. https://www.healthcaredive.com/news/goodrx-benefits-check-pr...