CARLA TANAKA
Subscriber on policy B09M000876
Claims
2
Attributed to this person
Charged
801.00
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 | CARLA TANAKA |
| Role on the policy | Subscriber |
| Policy | B09M000876 |
| Date of birth | 20 Nov 1978 |
| Plan | BRONZE EPO |
| Covered from | 26 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 111.15 |
| Total | 111.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003716 | 30 Sep 2025 | 171.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003715 | 2 Aug 2025 | 630.00 | CASCADE CARE | Not denied | — |