YUSUF REYES
Subscriber on policy B06M000063
Claims
2
Attributed to this person
Charged
986.00
Total submitted
Denied
112.00
2 denied claims
Patient responsibility
568.10
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 | YUSUF REYES |
| Role on the policy | Subscriber |
| Policy | B06M000063 |
| Date of birth | 26 Aug 1955 |
| Plan | SILVER HMO |
| Covered from | 11 Feb 2024 |
| Covered to | 1 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 568.10 |
| Total | 568.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000344 | 23 Jul 2024 | 874.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000343 | 1 Jul 2024 | 112.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 112.00 |