Out-of-Pocket Maximum and Deductible Tracker Audit

Audit your running deductible and out-of-pocket totals against insurer statements, spot uncounted payments, and list what to request.

Added October 15, 2026. Written with AI assistance and checked for clarity and placeholders; not reviewed by a lawyer, accountant, clinician or other professional. How these prompts are made

The Open buttons send the prompt text as currently shown below to that site only when you click. Fill in the placeholders first.

[VERIFY] is an editorial flag, not a blank to fill. Wherever the prompt shows [VERIFY], check that item against a reliable source before you use it (what [VERIFY] means).

I keep my own list of what I have paid toward my deductible and out-of-pocket maximum this plan year, and I want you to check it against the insurer's statements. Please treat this as bookkeeping only.

Inputs: my personal log [MY_PAYMENT_LOG], the insurer's year-to-date summary [INSURER_YTD_SUMMARY], plan year start and end dates [PLAN_YEAR_DATES], the deductible and out-of-pocket maximum stated in my plan summary [PLAN_LIMITS], and the family members covered [COVERED_MEMBERS].

Please do the following. First, build a reconciliation table: Date, Provider, My amount paid, Amount counted by insurer, Difference, Note. Second, total each column and show the arithmetic. Third, list payments I made that the insurer has not counted, with a possible reason for each category (claim not yet processed, payment to a provider outside the plan, premium or non-covered item that normally does not count, pending claim), clearly labelled as possibilities. Fourth, state how far I am from the deductible and from the out-of-pocket maximum using the insurer's figures and again using mine. Fifth, write a request of up to 150 words asking the plan for a claim-by-claim accumulator statement.

Guardrails: do not assume which expenses count; the plan documents decide, so mark any rule you mention as [VERIFY]. Do not predict future claims. Do not give financial or insurance advice, only help me organise questions.

Add a worked example with invented figures: deductible 1,500.00, my log shows 1,380.00 paid, insurer shows 1,240.00. Show the 140.00 gap and how you would trace it.

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Reconciliation summary (invented data)
My log total: 1,380.00. Insurer total: 1,240.00. Gap: 140.00.
Untracked items: 3 March physio payment 90.00 (not on insurer list; possible cause: provider outside plan or claim pending). 12 June pharmacy 50.00 (possible cause: pharmacy paid cash outside insurance).
Gap check: 90.00 + 50.00 = 140.00, fully explained as possibilities.
Remaining to deductible: 1,500.00 - 1,240.00 = 260.00 by insurer figures; 120.00 by my figures.
Next step: ask the plan whether items on 3 March and 12 June were received and whether they count. [VERIFY] counting rules in plan summary.

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