RAVI REYES
Dependent on policy B09M000592
Claims
1
Attributed to this person
Charged
841.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
546.65
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 | RAVI REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000592 |
| Date of birth | 7 Dec 1994 |
| Plan | GOLD PPO |
| Covered from | 23 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 546.65 |
| Total | 546.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002512 | 9 May 2025 | 841.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |