TOMAS USMAN
Dependent on policy B07M000512
Claims
3
Attributed to this person
Charged
1,758.00
Total submitted
Denied
484.00
1 denied claims
Patient responsibility
87.45
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000512 |
| Date of birth | 6 Jan 1981 |
| Plan | BRONZE EPO |
| Covered from | 1 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 87.45 |
| Total | 87.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002184 | 11 Aug 2026 | 691.00 | CASCADE CARE | Not denied | — |
| CLM0002186 | 2 May 2026 | 484.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 484.00 |
| CLM0002185 | 1 Mar 2025 | 583.00 | CASCADE CARE | Not denied | — |