HENRY TANAKA
Subscriber on policy B08M000169
Claims
1
Attributed to this person
Charged
804.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
160.80
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 | HENRY TANAKA |
| Role on the policy | Subscriber |
| Policy | B08M000169 |
| Date of birth | 22 Dec 1977 |
| Plan | SILVER HMO |
| Covered from | 21 Aug 2024 |
| Covered to | 16 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 160.80 |
| Total | 160.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000774 | 30 Jan 2025 | 804.00 | CASCADE CARE | Not denied | — |