RAVI KUMAR
Dependent on policy B01M000098
Claims
2
Attributed to this person
Charged
1,344.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
303.55
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 | RAVI KUMAR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000098 |
| Date of birth | 6 Feb 1989 |
| Plan | BRONZE EPO |
| Covered from | 26 Mar 2024 |
| Covered to | 6 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 303.55 |
| Total | 303.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000393 | 14 Jun 2024 | 877.00 | CASCADE CARE | Not denied | — |
| CLM0000392 | 29 May 2024 | 467.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |