Insurance Deductible Tracker (Free PDF Log)

Log claims, insurance payments, and your out-of-pocket costs so you know how close you are to meeting your deductible and can share a clear record for appeals or reimbursements.

Deductible tracker

Track claims, insurance payments, and your out-of-pocket costs toward this plan year’s deductible in a printable log.

Insured name

Insurer name

Policy number

Plan year

Deductible amount

Summary notes

Deductible entries

List each claim and payment toward your deductible.

Date

Provider / Service

Claim number

Billed amount

Insurance paid

Patient paid

Summary

Deductible amount: $-

Total patient paid: $0.00

Remaining to deductible: $-

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