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    Medical Expenses & Claims YEAR

    Uploaded by

    Colette Jenkins
    The document is a template for tracking a family's medical expenses and insurance claims for a given year. It includes tables with columns for the date of service, provider, description of service, whether an explanation of benefits was received, amounts billed, paid by insurance, paid as copays or deductibles, still due, and payment method. There are tables for tracking this information for multiple family members. The purpose is to consolidate information about medical bills, insurance payments, and out-of-pocket expenses in one place for tax and reimbursement purposes.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Medical Expenses & Claims YEAR

    Uploaded by

    Colette Jenkins
    31 views3 pages
    The document is a template for tracking a family's medical expenses and insurance claims for a given year. It includes tables with columns for the date of service, provider, description of service, whether an explanation of benefits was received, amounts billed, paid by insurance, paid as copays or deductibles, still due, and payment method. There are tables for tracking this information for multiple family members. The purpose is to consolidate information about medical bills, insurance payments, and out-of-pocket expenses in one place for tax and reimbursement purposes.

    Original Title

    Medical-Expense-Spreadsheet

    Copyright

    © © All Rights Reserved

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    XLSX, PDF, TXT or read online from Scribd

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    The document is a template for tracking a family's medical expenses and insurance claims for a given year. It includes tables with columns for the date of service, provider, description of service, whether an explanation of benefits was received, amounts billed, paid by insurance, paid as copays or deductibles, still due, and payment method. There are tables for tracking this information for multiple family members. The purpose is to consolidate information about medical bills, insurance payments, and out-of-pocket expenses in one place for tax and reimbursement purposes.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    31 views3 pages

    Medical Expenses & Claims YEAR

    Uploaded by

    Colette Jenkins
    The document is a template for tracking a family's medical expenses and insurance claims for a given year. It includes tables with columns for the date of service, provider, description of service, whether an explanation of benefits was received, amounts billed, paid by insurance, paid as copays or deductibles, still due, and payment method. There are tables for tracking this information for multiple family members. The purpose is to consolidate information about medical bills, insurance payments, and out-of-pocket expenses in one place for tax and reimbursement purposes.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    You are on page 1of 3

    MEDICAL EXPENSES & CLAIMS

    YEAR ______
    FAMILY MEMBER: ______________________________

    EOB AMOUNT INSURANCE COPAY DEDUCTIBLE AMOUNT METHOD OF


    DATE PROVIDER DESCRIPTION OF SERVICE RECEIVED? BILLED AMOUNT PAID AMOUNT PAID AMOUNT PAID STILL DUE PAYMENT NOTES
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00 0.00 0.00 0.00 0.00

    FAMILY MEMBER: ______________________________

    EOB AMOUNT INSURANCE COPAY DEDUCTIBLE AMOUNT METHOD OF


    DATE PROVIDER DESCRIPTION OF SERVICE RECEIVED? BILLED AMOUNT PAID AMOUNT PAID AMOUNT PAID STILL DUE PAYMENT NOTES
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00 0.00 0.00 0.00 0.00

    © 2016 www.makingyourmoneymatter.com
    FAMILY MEMBER: ______________________________

    EOB AMOUNT INSURANCE COPAY DEDUCTIBLE AMOUNT METHOD OF


    DATE PROVIDER DESCRIPTION OF SERVICE RECEIVED? BILLED AMOUNT PAID AMOUNT PAID AMOUNT PAID STILL DUE PAYMENT NOTES
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00 0.00 0.00 0.00 0.00

    FAMILY MEMBER: ______________________________

    EOB AMOUNT INSURANCE COPAY DEDUCTIBLE AMOUNT METHOD OF


    DATE PROVIDER DESCRIPTION OF SERVICE RECEIVED? BILLED AMOUNT PAID AMOUNT PAID AMOUNT PAID STILL DUE PAYMENT NOTES
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00
    0.00 0.00 0.00 0.00 0.00

    TOTAL AMOUNTS 0.00 0.00 0.00 0.00 0.00


    © 2016 www.makingyourmoneymatter.com

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