GRACE ANDERSON
Dependent on policy B08M000304
Claims
1
Attributed to this person
Charged
74.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
48.10
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 | GRACE ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000304 |
| Date of birth | 2 Aug 1982 |
| Plan | BRONZE EPO |
| Covered from | 30 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 48.10 |
| Total | 48.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001411 | 9 Mar 2025 | 74.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |