SOFIA ANDERSON
Dependent on policy B01M000795
Claims
3
Attributed to this person
Charged
1,171.00
Total submitted
Denied
273.00
1 denied claims
Patient responsibility
125.70
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 | SOFIA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000795 |
| Date of birth | 16 May 1993 |
| Plan | BRONZE EPO |
| Covered from | 14 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 125.70 |
| Total | 125.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003535 | 28 Apr 2026 | 838.00 | CASCADE CARE | Not denied | — |
| CLM0003533 | 7 Sep 2025 | 60.00 | CASCADE CARE | Not denied | — |
| CLM0003534 | 11 Aug 2025 | 273.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 273.00 |