TOMAS USMAN
Subscriber on policy B01M000613
Claims
3
Attributed to this person
Charged
1,875.00
Total submitted
Denied
713.00
2 denied claims
Patient responsibility
377.00
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 | Subscriber |
| Policy | B01M000613 |
| Date of birth | 12 Jan 1959 |
| Plan | PLATINUM PPO |
| Covered from | 26 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 377.00 |
| Total | 377.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002733 | 29 Jul 2026 | 582.00 | CASCADE CARE | Not denied | — |
| CLM0002732 | 14 Nov 2024 | 580.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002731 | 8 Jun 2024 | 713.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 713.00 |