KEVIN REYES
Subscriber on policy B10M000764
Claims
2
Attributed to this person
Charged
1,107.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
543.40
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 | KEVIN REYES |
| Role on the policy | Subscriber |
| Policy | B10M000764 |
| Date of birth | 18 Mar 1979 |
| Plan | PLATINUM PPO |
| Covered from | 19 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 543.40 |
| Total | 543.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003199 | 29 Dec 2024 | 836.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003200 | 31 Oct 2024 | 271.00 | CASCADE CARE | Not denied | — |