UMA REYES
Subscriber on policy B10M000067
Claims
3
Attributed to this person
Charged
1,372.00
Total submitted
Denied
623.00
1 denied claims
Patient responsibility
103.20
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 | UMA REYES |
| Role on the policy | Subscriber |
| Policy | B10M000067 |
| Date of birth | 16 Jul 1955 |
| Plan | GOLD PPO |
| Covered from | 1 Jun 2025 |
| Covered to | 22 Feb 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 103.20 |
| Total | 103.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000268 | 4 Feb 2026 | 233.00 | CASCADE CARE | Not denied | — |
| CLM0000269 | 26 Oct 2025 | 516.00 | CASCADE CARE | Not denied | — |
| CLM0000267 | 22 Oct 2025 | 623.00 | CASCADE CARE | CARC 18 · DUPLICATE | 623.00 |