IVAN YAMADA
Subscriber on policy B01M000657
Claims
3
Attributed to this person
Charged
1,673.00
Total submitted
Denied
0.00
2 denied claims
Patient responsibility
787.15
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 | IVAN YAMADA |
| Role on the policy | Subscriber |
| Policy | B01M000657 |
| Date of birth | 31 May 1982 |
| Plan | BRONZE EPO |
| Covered from | 8 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 403.00 |
| CARC 50 · Other | 1 | 384.15 |
| Total | 787.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002935 | 15 Jun 2025 | 591.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002937 | 13 Feb 2025 | 462.00 | CASCADE CARE | Not denied | — |
| CLM0002936 | 20 May 2024 | 620.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |