KEVIN TANAKA
Subscriber on policy B10M000400
Claims
1
Attributed to this person
Charged
433.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
86.60
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 | KEVIN TANAKA |
| Role on the policy | Subscriber |
| Policy | B10M000400 |
| Date of birth | 3 May 1967 |
| Plan | SILVER HMO |
| Covered from | 16 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 86.60 |
| Total | 86.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001656 | 22 May 2025 | 433.00 | NORTHSTAR MUTUAL | Not denied | — |