BRIAN REYES
Subscriber on policy B08M000028
Claims
3
Attributed to this person
Charged
1,393.00
Total submitted
Denied
541.74
2 denied claims
Patient responsibility
111.60
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 REYES |
| Role on the policy | Subscriber |
| Policy | B08M000028 |
| Date of birth | 13 Dec 2003 |
| Plan | BRONZE EPO |
| Covered from | 28 Sep 2024 |
| Covered to | 23 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 111.60 |
| Total | 111.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000123 | 8 Aug 2025 | 465.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 465.00 |
| CLM0000125 | 2 Nov 2024 | 184.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 76.74 |
| CLM0000124 | 24 Oct 2024 | 744.00 | CASCADE CARE | Not denied | — |