CARLA ANDERSON
Subscriber on policy B09M000028
Claims
3
Attributed to this person
Charged
832.00
Total submitted
Denied
107.00
2 denied claims
Patient responsibility
267.80
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 | CARLA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B09M000028 |
| Date of birth | 29 Jul 1977 |
| Plan | SILVER HMO |
| Covered from | 17 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 267.80 |
| Total | 267.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000122 | 3 Jun 2026 | 412.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000123 | 28 Nov 2025 | 313.00 | CASCADE CARE | Not denied | — |
| CLM0000124 | 26 May 2025 | 107.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 107.00 |