HENRY USMAN
Subscriber on policy B08M000399
Claims
2
Attributed to this person
Charged
607.00
Total submitted
Denied
76.00
1 denied claims
Patient responsibility
106.20
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B08M000399 |
| Date of birth | 28 Apr 1967 |
| Plan | SILVER HMO |
| Covered from | 6 Jan 2024 |
| Covered to | 27 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 106.20 |
| Total | 106.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001828 | 6 Jan 2024 | 531.00 | CASCADE CARE | Not denied | — |
| CLM0001827 | 12 Dec 2023 | 76.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 76.00 |