FIONA USMAN
Dependent on policy B01M000494
Claims
1
Attributed to this person
Charged
163.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
32.60
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 | FIONA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000494 |
| Date of birth | 7 Oct 1978 |
| 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 | 32.60 |
| Total | 32.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002209 | 29 Jan 2025 | 163.00 | CASCADE CARE | Not denied | — |