YUSUF TANAKA
Dependent on policy B07M000514
Claims
1
Attributed to this person
Charged
526.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
105.20
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 TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000514 |
| Date of birth | 23 May 2009 |
| Plan | BRONZE EPO |
| Covered from | 6 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 105.20 |
| Total | 105.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002198 | 31 Jan 2025 | 526.00 | MERIDIAN HEALTH PLAN | Not denied | — |