GRACE QUINN
Dependent on policy B10M000899
Claims
2
Attributed to this person
Charged
949.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
110.80
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 QUINN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000899 |
| Date of birth | 19 Apr 2012 |
| Plan | BRONZE EPO |
| Covered from | 22 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 110.80 |
| Total | 110.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003831 | 26 Jul 2026 | 395.00 | CASCADE CARE | Not denied | — |
| CLM0003830 | 11 Nov 2024 | 554.00 | CASCADE CARE | Not denied | — |