GRACE USMAN
Subscriber on policy B06M000284
Claims
2
Attributed to this person
Charged
1,196.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
551.85
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 | GRACE USMAN |
| Role on the policy | Subscriber |
| Policy | B06M000284 |
| Date of birth | 20 Apr 1951 |
| Plan | GOLD PPO |
| Covered from | 14 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 551.85 |
| Total | 551.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001321 | 18 Jun 2025 | 849.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001320 | 1 Mar 2025 | 347.00 | CASCADE CARE | Not denied | — |