10/23/2026
Here’s a question we’d genuinely love someone to answer. 🤔💊
We pay for health insurance every month. We have set copays for our appointments, and we pay them. Yet we’ve experienced receiving additional bills months later, with the explanation that insurance didn’t cover the full cost.
Meanwhile, as independent pharmacy owners, we see insurance reimbursements that don’t even cover what we paid to purchase a medication every single day.
And here’s the difference: We generally cannot turn around and bill our patients for that reimbursement shortfall. Doing so on a covered claim could put our insurance contracts at risk.
So why does it appear that some medical, dental, and other healthcare offices can collect additional balances after insurance processes a claim, while pharmacies are expected to absorb below-cost reimbursements?
We absolutely believe EVERY healthcare provider deserves to be fairly compensated. This isn’t about criticizing doctors or dentists.
It’s about asking why pharmacies are operating under reimbursement arrangements that require them to dispense medications at a financial loss every single day.
And to be clear, legitimate deductibles, coinsurance, and separately covered services are different from simply billing a patient because insurance paid less than the provider wanted.
If pharmacies can’t recover the difference between acquisition cost and reimbursement, why is that considered an acceptable way to operate?
We’d love to hear from other healthcare professionals. Is there something we’re missing, or is this another example of how broken our healthcare reimbursement system has become?
