GRACE TANAKA
Dependent on policy B07M000008
Claims
1
Attributed to this person
Charged
842.00
Total submitted
Denied
842.00
1 denied claims
Patient responsibility
0.00
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 TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000008 |
| Date of birth | 21 Aug 2000 |
| Plan | PLATINUM PPO |
| Covered from | 22 May 2024 |
| Covered to | 13 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000053 | 22 Jan 2025 | 842.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 842.00 |