GRACE FOSTER
Subscriber on policy B10M000115
Claims
2
Attributed to this person
Charged
1,055.00
Total submitted
Denied
215.40
2 denied claims
Patient responsibility
358.15
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 | GRACE FOSTER |
| Role on the policy | Subscriber |
| Policy | B10M000115 |
| Date of birth | 9 Dec 1991 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 2025 |
| Covered to | 22 Jan 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 358.15 |
| Total | 358.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000472 | 28 Feb 2026 | 551.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000471 | 3 Oct 2025 | 504.00 | CASCADE CARE | CARC 11 · CODING | 215.40 |