DAVID ANDERSON
Dependent on policy B07M000790
Claims
2
Attributed to this person
Charged
454.00
Total submitted
Denied
454.00
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000790 |
| Date of birth | 20 Jul 1956 |
| Plan | GOLD PPO |
| Covered from | 9 Sep 2024 |
| Covered to | 9 Jun 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 |
|---|---|---|---|---|---|
| CLM0003263 | 29 Jun 2025 | 133.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 133.00 |
| CLM0003264 | 22 Aug 2024 | 321.00 | CASCADE CARE | CARC 18 · DUPLICATE | 321.00 |