GRACE TANAKA
Dependent on policy B10M000532
Claims
1
Attributed to this person
Charged
177.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | GRACE TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000532 |
| Date of birth | 30 Jun 2022 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2024 |
| Covered to | 28 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002210 | 14 May 2024 | 177.00 | MERIDIAN HEALTH PLAN | Not denied | — |