HENRY USMAN
Dependent on policy B09M000595
Claims
3
Attributed to this person
Charged
913.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
111.15
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 | HENRY USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000595 |
| Date of birth | 10 Dec 2005 |
| Plan | SILVER HMO |
| Covered from | 4 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 111.15 |
| Total | 111.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002523 | 22 Apr 2026 | 171.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002525 | 17 Jul 2024 | 498.00 | CASCADE CARE | Not denied | — |
| CLM0002524 | 23 May 2024 | 244.00 | CASCADE CARE | Not denied | — |