RAVI PATEL
Dependent on policy B08M000740
Claims
3
Attributed to this person
Charged
1,686.00
Total submitted
Denied
563.00
1 denied claims
Patient responsibility
117.75
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 | RAVI PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000740 |
| Date of birth | 12 May 1965 |
| Plan | SILVER HMO |
| Covered from | 9 Jan 2024 |
| Covered to | 29 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 117.75 |
| Total | 117.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003313 | 23 Aug 2024 | 563.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 563.00 |
| CLM0003314 | 26 Mar 2024 | 338.00 | CASCADE CARE | Not denied | — |
| CLM0003312 | 22 Dec 2023 | 785.00 | CASCADE CARE | Not denied | — |