CARLA REYES
Dependent on policy B10M000667
Claims
1
Attributed to this person
Charged
174.00
Total submitted
Denied
174.00
1 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 | CARLA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000667 |
| Date of birth | 10 Apr 1982 |
| Plan | BRONZE EPO |
| Covered from | 9 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002773 | 18 Feb 2024 | 174.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 174.00 |