ELENA REYES
Dependent on policy B10M000594
Claims
2
Attributed to this person
Charged
365.00
Total submitted
Denied
365.00
2 denied claims
Patient responsibility
0.00
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 | ELENA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000594 |
| Date of birth | 9 Sep 1967 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jan 2024 |
| Covered to | 25 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002457 | 16 Aug 2024 | 252.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 252.00 |
| CLM0002458 | 31 Mar 2024 | 113.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 113.00 |