GRACE REYES
Dependent on policy B10M000602
Claims
2
Attributed to this person
Charged
431.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
74.20
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 | GRACE REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000602 |
| Date of birth | 23 Feb 1991 |
| Plan | SILVER HMO |
| Covered from | 14 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 74.20 |
| Total | 74.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002506 | 18 Dec 2025 | 60.00 | CASCADE CARE | Not denied | — |
| CLM0002507 | 27 May 2025 | 371.00 | CASCADE CARE | Not denied | — |