IVAN TANAKA
Subscriber on policy B08M000055
Claims
1
Attributed to this person
Charged
308.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | IVAN TANAKA |
| Role on the policy | Subscriber |
| Policy | B08M000055 |
| Date of birth | 8 Nov 1970 |
| Plan | SILVER HMO |
| Covered from | 27 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000243 | 14 Jul 2025 | 308.00 | MERIDIAN HEALTH PLAN | Not denied | — |