I used to buy loads of Newegg refurb video cards, but rarely now even look at them. The savings isn't as good anymore IMO.
As far as reliability; I had a couple that were bad as delivered. As long as you test them right away within the 14 days, you can RMA it. You lose the $1 shipping and have to pay the return shipping. So there is a gamble, but it can be worth it if it's a good enough savings. Also, chances are on the best refurb deals they sell, you get the card only. Sometimes you see 2 of the same exact cards refurbed and one is $15 cheaper. That's usually becasue the more expensive one has more of the bundle (cables, adapters, software) included.
But for me I had 4 of my refurbs that originally were fine, die a premature death less than a year later. And these cards were not used daily. Abit replaced the one card, the Aopen and 2 Gainwards I took the hit. I'm guestimating I have bought maybe 20 newegg refurb cards. I'd say from my expereince with newegg refurbs, maybe 1 out of 10 is bad when you get it and 2 out of 10 will die early, maybe within a year. Now this is by no means fact, it's just what I experienced with cards I purchased 1-3 years ago. I tell you one thing, I'd never buy a refurb from Crucial. I ordered a 9700 pro a few months ago that artifacted like crazy as soon as I got it. And with Crucial, I had to pay return shipping and could only get store credit, not a refund. I had it out for a while with crucial customer service as I was shocked by their lousy refurb policy. Anyway, that pretty much just did me in for all refurbs except directly from ATI themselves. ATI honors the 3 year warranty on their refurbs bought directly from them.
I would not spend that much on a refurb unless it was much better card, like a 7800GS for $180. And then I would test the daylights out of it as soon as you get it. A couple weeks ago you could buy an equal card, the AGP X800XL brand new for that price. I don't really like AGP 6800GS for $200 and would buy a $155 X800GTO instead, but I think If I had to choose, I would spend $200 on a new 6800GS and OC/mod it before I'd buy a 6800GT refurb for $180. That's my 2 cents anyway.