RAVI REYES
Subscriber on policy B10M000356
Claims
1
Attributed to this person
Charged
499.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
324.35
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 | RAVI REYES |
| Role on the policy | Subscriber |
| Policy | B10M000356 |
| Date of birth | 25 Oct 1962 |
| Plan | BRONZE EPO |
| Covered from | 8 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 324.35 |
| Total | 324.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001486 | 17 Jul 2024 | 499.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |