LEILA ANDERSON
Dependent on policy B01M000265
Claims
2
Attributed to this person
Charged
1,338.00
Total submitted
Denied
646.00
1 denied claims
Patient responsibility
103.80
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 | LEILA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000265 |
| Date of birth | 19 Dec 1966 |
| Plan | SILVER HMO |
| Covered from | 2 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 103.80 |
| Total | 103.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001129 | 18 Jul 2025 | 692.00 | CASCADE CARE | Not denied | — |
| CLM0001130 | 23 May 2025 | 646.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 646.00 |