OMAR USMAN
Subscriber on policy B01M000494
Claims
2
Attributed to this person
Charged
1,171.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
119.00
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 | OMAR USMAN |
| Role on the policy | Subscriber |
| Policy | B01M000494 |
| Date of birth | 22 Sep 1955 |
| Plan | PLATINUM PPO |
| Covered from | 28 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 119.00 |
| Total | 119.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002203 | 28 Nov 2024 | 595.00 | CASCADE CARE | Not denied | — |
| CLM0002205 | 10 Jun 2024 | 576.00 | CASCADE CARE | Not denied | — |