TOMAS USMAN
Dependent on policy B09M000634
Claims
1
Attributed to this person
Charged
708.00
Total submitted
Denied
270.25
1 denied claims
Patient responsibility
0.00
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000634 |
| Date of birth | 28 May 1974 |
| Plan | BRONZE EPO |
| Covered from | 7 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002693 | 9 Feb 2025 | 708.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 270.25 |