CARLA HUGHES
Dependent on policy B09M000630
Claims
1
Attributed to this person
Charged
558.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.00
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 HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000630 |
| Date of birth | 14 Aug 1976 |
| Plan | GOLD PPO |
| Covered from | 29 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002674 | 15 Oct 2024 | 558.00 | CASCADE CARE | Not denied | — |