CARLA TANAKA
Dependent on policy B08M000720
Claims
3
Attributed to this person
Charged
1,914.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
419.75
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 | CARLA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000720 |
| Date of birth | 2 Feb 2020 |
| Plan | GOLD PPO |
| Covered from | 23 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 330.20 |
| CARC 1 · Deductible | 1 | 89.55 |
| Total | 419.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003241 | 20 Nov 2025 | 597.00 | CASCADE CARE | Not denied | — |
| CLM0003242 | 21 Sep 2025 | 809.00 | CASCADE CARE | Not denied | — |
| CLM0003243 | 23 Jun 2025 | 508.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |