BRIAN REYES
Subscriber on policy B01M000290
Claims
3
Attributed to this person
Charged
1,384.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
89.80
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 | BRIAN REYES |
| Role on the policy | Subscriber |
| Policy | B01M000290 |
| Date of birth | 1 Dec 2000 |
| Plan | PLATINUM PPO |
| Covered from | 31 May 2025 |
| Covered to | 3 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 89.80 |
| Total | 89.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001269 | 5 Sep 2025 | 449.00 | CASCADE CARE | Not denied | — |
| CLM0001268 | 7 Aug 2025 | 650.00 | CASCADE CARE | Not denied | — |
| CLM0001267 | 31 Jul 2025 | 285.00 | CASCADE CARE | Not denied | — |