BRIAN FOSTER
Dependent on policy B01M000220
Claims
2
Attributed to this person
Charged
949.00
Total submitted
Denied
269.83
2 denied claims
Patient responsibility
110.50
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 | BRIAN FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000220 |
| Date of birth | 10 Aug 1997 |
| Plan | SILVER HMO |
| Covered from | 22 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 110.50 |
| Total | 110.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000937 | 6 May 2026 | 779.00 | CASCADE CARE | CARC 18 · DUPLICATE | 269.83 |
| CLM0000936 | 22 Nov 2024 | 170.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |