LEILA YAMADA
Subscriber on policy B08M000221
Claims
3
Attributed to this person
Charged
1,570.00
Total submitted
Denied
206.00
2 denied claims
Patient responsibility
633.60
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 | LEILA YAMADA |
| Role on the policy | Subscriber |
| Policy | B08M000221 |
| Date of birth | 25 Jul 1972 |
| Plan | GOLD PPO |
| Covered from | 7 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 557.70 |
| CARC 1 · Deductible | 1 | 75.90 |
| Total | 633.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000978 | 12 Oct 2025 | 858.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000979 | 30 Aug 2024 | 206.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 206.00 |
| CLM0000980 | 3 Aug 2024 | 506.00 | CASCADE CARE | Not denied | — |