ZARA REYES
Subscriber on policy B06M000638
Claims
2
Attributed to this person
Charged
490.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
39.40
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 REYES |
| Role on the policy | Subscriber |
| Policy | B06M000638 |
| Date of birth | 21 Jul 1997 |
| Plan | BRONZE EPO |
| Covered from | 22 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 39.40 |
| Total | 39.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002845 | 16 Nov 2024 | 197.00 | CASCADE CARE | Not denied | — |
| CLM0002844 | 9 Jul 2024 | 293.00 | CASCADE CARE | Not denied | — |