VICTOR REYES
Dependent on policy B07M000630
Claims
3
Attributed to this person
Charged
1,202.00
Total submitted
Denied
1,023.17
3 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 | VICTOR REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000630 |
| Date of birth | 7 Dec 2014 |
| Plan | BRONZE EPO |
| Covered from | 7 Feb 2024 |
| Covered to | 11 Apr 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 |
|---|---|---|---|---|---|
| CLM0002643 | 25 May 2024 | 833.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 833.00 |
| CLM0002644 | 11 Apr 2024 | 306.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 127.17 |
| CLM0002642 | 8 Jan 2024 | 63.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 63.00 |