PRIYA ANDERSON
Subscriber on policy B10M000757
Claims
1
Attributed to this person
Charged
601.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
120.20
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 | PRIYA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B10M000757 |
| Date of birth | 24 Sep 1960 |
| Plan | BRONZE EPO |
| Covered from | 24 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 120.20 |
| Total | 120.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003173 | 29 Sep 2024 | 601.00 | CASCADE CARE | Not denied | — |