Medical expenses and non-reimbursable fees?

Hello, I'm not particular interested in tracking each individual expense but I do once a month update my ledger to reflect all of my bank and brokerage accounts. I do however want to keep track of money owed or certain expenses like medical expenses.

Let's say I pay my expenses from credit card or via my bank directly. I don't keep track of my credit card accounts because they're too noisy and transient. And if I pay a medical expense via my bank account then it's either already reflected in my balances or will be - I'm not sweating it either way.

For tracking medical expenses and reimbursements I have a medical.ledger file that has entries like:

2025-08-29  * medical payment to doctor ; Aug Bill $1100
    expenses:doc_a                $1100
    assets:insurance:receivable     (-$1100*0.8)
    equity:insurance:outofpocket    (-$1100*0.2)

2025-09-18 * Deposit Mobile Banking ; reimbursement
    assets:insurance:receivable     $880
    equity:insurance:reimbursement

and this appears to balance but any thoughts are appreciated on how to improve it.

What I'm trying to grapple with is if I have a non-reimbursable charge like a no-show or something as part of my bill. I guess I can either split it out into individual transactions but I would like to understand how I could book this as part of a large transaction.

2025-12-05 medical payment to doctor ; Dec (Paid $875)
    expenses:doc_a                $550
    expenses:doc_a:no-show        $275
    assets:insurance:receivable     -$440
    equity:insurance:outofpocket    -$110

2025-09-18 * Deposit Mobile Banking ; Reimbursement
    assets:insurance:receivable     $440
    equity:insurance:reimbursement

but the above doesn't balance because of where to book the no-show against? I don't want to comingle it with my insurance because it's neither reimbursable nor counts towards any max spend. I can't book it against my bank or credit card because the original payment of $825 is already there. Should I just split it out and book it separately? I think the downside to that is when I'm combing through certain expenses I'll need to be cognizant of some 825 bank charge matching against a 550 and 275 charges.

1 Like

A few thoughts:

assets:insurance:receivable should be positive, not negative.

Why not balance expenses:doc_a:no_show against equity (since you're not tracking bank assets here), as you do with the main expense.

The reimbursable portion isn't your expense (or if recorded as such, should be cancelled by a negative expense when received).

How about something like this (I didn't bother to split up equity or show the calculations, and I adjusted the amount in the description):

2025-12-05 medical payment to doctor ; Dec (Paid $825)
    expenses:doc_a                              $110
    assets:insurance:receivable                 $440
    expenses:doc_a:no-show                      $275
    equity

2025-12-18 * Deposit Mobile Banking ; Reimbursement
    assets:insurance:receivable                $-440 = $0
    equity