GRACE USMAN
Subscriber on policy B01M000116
Claims
1
Attributed to this person
Charged
841.00
Total submitted
Denied
841.00
1 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 | GRACE USMAN |
| Role on the policy | Subscriber |
| Policy | B01M000116 |
| Date of birth | 8 Jun 1952 |
| Plan | GOLD PPO |
| Covered from | 22 Apr 2025 |
| Covered to | 9 Sep 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 |
|---|---|---|---|---|---|
| CLM0000454 | 28 Jun 2025 | 841.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 841.00 |