TOMAS TANAKA
Dependent on policy B08M000434
Claims
3
Attributed to this person
Charged
1,054.00
Total submitted
Denied
504.00
1 denied claims
Patient responsibility
23.70
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 | TOMAS TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000434 |
| Date of birth | 25 Mar 1999 |
| Plan | GOLD PPO |
| Covered from | 9 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 23.70 |
| Total | 23.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001993 | 22 Aug 2025 | 392.00 | CASCADE CARE | Not denied | — |
| CLM0001994 | 18 Dec 2024 | 158.00 | CASCADE CARE | Not denied | — |
| CLM0001992 | 19 Feb 2024 | 504.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 504.00 |