CARLA USMAN
Dependent on policy B09M000578
Claims
3
Attributed to this person
Charged
1,667.00
Total submitted
Denied
286.00
1 denied claims
Patient responsibility
114.60
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 | CARLA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000578 |
| Date of birth | 6 Dec 2009 |
| Plan | BRONZE EPO |
| Covered from | 2 Jun 2024 |
| Covered to | 14 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 114.60 |
| Total | 114.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002449 | 23 Apr 2025 | 286.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 286.00 |
| CLM0002447 | 27 Sep 2024 | 573.00 | CASCADE CARE | Not denied | — |
| CLM0002448 | 7 May 2024 | 808.00 | CASCADE CARE | Not denied | — |