DAVID REYES
Subscriber on policy B07M000036
Claims
2
Attributed to this person
Charged
1,013.00
Total submitted
Denied
1,013.00
2 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 | DAVID REYES |
| Role on the policy | Subscriber |
| Policy | B07M000036 |
| Date of birth | 23 Jan 1997 |
| Plan | GOLD PPO |
| Covered from | 27 Feb 2024 |
| Covered to | 11 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000170 | 16 Apr 2024 | 307.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 307.00 |
| CLM0000169 | 2 Mar 2024 | 706.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 706.00 |