OMAR PATEL
Dependent on policy B01M000137
Claims
2
Attributed to this person
Charged
1,026.00
Total submitted
Denied
153.04
1 denied claims
Patient responsibility
76.05
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 | OMAR PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000137 |
| Date of birth | 5 Jan 2003 |
| Plan | GOLD PPO |
| Covered from | 23 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 76.05 |
| Total | 76.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000560 | 29 Jun 2025 | 507.00 | CASCADE CARE | Not denied | — |
| CLM0000559 | 23 Aug 2024 | 519.00 | CASCADE CARE | CARC 18 · DUPLICATE | 153.04 |