How to Use This Worksheet

  1. Collect your EOBs — Gather the Explanation of Benefits statements from your insurance company for the medical visits you want to track.
  2. Match each EOB to the provider bill — For each visit, write down what the provider billed, what insurance paid, and what the EOB says you owe.
  3. Spot discrepancies — If the provider bill shows a different "you owe" amount than your EOB, highlight it. That's a potential billing error.
  4. Track payments — Mark each bill as paid once you've verified the correct amount.
  5. Ready to go digital?EOBVault does all of this automatically — tracks deductibles, highlights overcharges, and keeps everything in one place forever.
Medical Bill & EOB Reconciliation Worksheet
Patient: _________________________    Insurance Plan: _________________________    Policy #: _________________________
# Provider / Patient Service Date Service Type Billed Insurance Paid You Owe (EOB) You Owe (Bill) Match? Status Notes
EX City General Hospital
Pat: Jane Doe
01/15/26 ER Visit $4,200 $3,780 $420 $420 Paid Met deductible with this visit
EX Valley Radiology
Pat: Jane Doe
01/22/26 MRI $2,800 $2,240 $560 $560 Paid
EX Dr. Patel — Cardiology
Pat: Jane Doe
02/03/26 Follow-up $350 $280 $70 $70 Paid
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TOTALS
Deductible & Out-of-Pocket Tracker
Category Annual Limit Met So Far Remaining % Complete
EX Deductible $3,000 $1,050 $1,950 35%
EX Out-of-Pocket Max $7,500 $1,050 $6,450 14%
Deductible
Out-of-Pocket Max
Payment Log
Date Paid Provider Amount Method Confirmation # HSA/FSA?
EX 02/15/26 City General Hospital $420 Credit Card #CHG-8821 No
      
      
      
      

Ready to Go Digital?

EOBVault tracks all of this automatically — no paper, no spreadsheets, no account needed. See your deductible progress, spot billing errors, and keep every bill organized in one place. Free forever.

📋 Try EOBVault Free →

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Local-First All data stays on your device
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Deductible Tracking Auto-calculated from your bills
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Error Detection Spot overcharges instantly
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Works Everywhere Phone, tablet, desktop — offline too