ZARA REYES
Dependent on policy B07M000525
Claims
3
Attributed to this person
Charged
1,417.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
327.60
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 | Dependent · relationship 01 |
| Policy | B07M000525 |
| Date of birth | 16 May 1962 |
| Plan | GOLD PPO |
| Covered from | 15 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 327.60 |
| Total | 327.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002251 | 23 Aug 2025 | 590.00 | CASCADE CARE | Not denied | — |
| CLM0002250 | 3 May 2025 | 323.00 | CASCADE CARE | Not denied | — |
| CLM0002252 | 13 Sep 2024 | 504.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |