OMAR YAMADA
Dependent on policy B10M000513
Claims
3
Attributed to this person
Charged
641.00
Total submitted
Denied
180.00
1 denied claims
Patient responsibility
55.40
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 | OMAR YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000513 |
| Date of birth | 28 May 2020 |
| Plan | SILVER HMO |
| Covered from | 11 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 55.40 |
| Total | 55.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002119 | 11 May 2025 | 184.00 | CASCADE CARE | Not denied | — |
| CLM0002118 | 4 Sep 2024 | 180.00 | CASCADE CARE | CARC 109 · COB | 180.00 |
| CLM0002117 | 1 Sep 2024 | 277.00 | CASCADE CARE | Not denied | — |