WENDY USMAN
Subscriber on policy B08M000857
Claims
2
Attributed to this person
Charged
1,311.00
Total submitted
Denied
595.00
1 denied claims
Patient responsibility
107.40
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 | WENDY USMAN |
| Role on the policy | Subscriber |
| Policy | B08M000857 |
| Date of birth | 7 Sep 2001 |
| Plan | BRONZE EPO |
| Covered from | 13 Oct 2024 |
| Covered to | 17 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 107.40 |
| Total | 107.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003836 | 23 Jan 2025 | 595.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 595.00 |
| CLM0003837 | 17 Nov 2024 | 716.00 | CASCADE CARE | Not denied | — |