ZARA PATEL
Dependent on policy B06M000023
Claims
1
Attributed to this person
Charged
659.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
131.80
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | ZARA PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000023 |
| Date of birth | 14 Jul 1950 |
| Plan | GOLD PPO |
| Covered from | 6 Nov 2024 |
| Covered to | 13 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 131.80 |
| Total | 131.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000142 | 31 Oct 2024 | 659.00 | CASCADE CARE | Not denied | — |