IVAN FOSTER
Dependent on policy B01M000816
Claims
3
Attributed to this person
Charged
1,183.00
Total submitted
Denied
641.00
2 denied claims
Patient responsibility
245.65
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 | IVAN FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000816 |
| Date of birth | 10 Dec 1991 |
| Plan | SILVER HMO |
| Covered from | 3 Dec 2024 |
| Covered to | 7 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 198.25 |
| CARC 2 · Coinsurance | 1 | 47.40 |
| Total | 245.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003626 | 12 Aug 2025 | 305.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003628 | 24 Jan 2025 | 641.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 641.00 |
| CLM0003627 | 2 Jan 2025 | 237.00 | CASCADE CARE | Not denied | — |