FIONA REYES
Dependent on policy B09M000221
Claims
2
Attributed to this person
Charged
454.00
Total submitted
Denied
135.77
1 denied claims
Patient responsibility
32.40
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 | FIONA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000221 |
| Date of birth | 6 Feb 1998 |
| Plan | PLATINUM PPO |
| Covered from | 18 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 32.40 |
| Total | 32.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000922 | 12 Oct 2025 | 292.00 | CASCADE CARE | CARC 11 · CODING | 135.77 |
| CLM0000921 | 19 Apr 2025 | 162.00 | CASCADE CARE | Not denied | — |