SOFIA REYES
Dependent on policy B08M000445
Claims
3
Attributed to this person
Charged
2,560.00
Total submitted
Denied
830.00
2 denied claims
Patient responsibility
568.10
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 | SOFIA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000445 |
| Date of birth | 6 Jun 1992 |
| Plan | GOLD PPO |
| Covered from | 23 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 568.10 |
| Total | 568.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002051 | 10 Jul 2025 | 874.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002050 | 30 Dec 2024 | 830.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 830.00 |
| CLM0002052 | 27 Oct 2024 | 856.00 | CASCADE CARE | Not denied | — |