TOMAS FOSTER
Subscriber on policy B01M000816
Claims
3
Attributed to this person
Charged
1,973.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
175.65
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 | TOMAS FOSTER |
| Role on the policy | Subscriber |
| Policy | B01M000816 |
| Date of birth | 25 Nov 1955 |
| Plan | SILVER HMO |
| Covered from | 3 Dec 2024 |
| Covered to | 7 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 2 | 175.65 |
| Total | 175.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003624 | 29 Sep 2025 | 522.00 | CASCADE CARE | Not denied | — |
| CLM0003622 | 12 Feb 2025 | 802.00 | CASCADE CARE | Not denied | — |
| CLM0003623 | 10 Feb 2025 | 649.00 | CASCADE CARE | Not denied | — |