KEVIN YAMADA
Dependent on policy B09M000695
Claims
2
Attributed to this person
Charged
1,133.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
170.00
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 | KEVIN YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000695 |
| Date of birth | 17 Feb 1998 |
| Plan | SILVER HMO |
| Covered from | 7 Feb 2024 |
| Covered to | 4 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 170.00 |
| Total | 170.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002964 | 17 Jun 2024 | 283.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002965 | 8 Feb 2024 | 850.00 | MERIDIAN HEALTH PLAN | Not denied | — |