ELENA HUGHES
Dependent on policy B01M000867
Claims
2
Attributed to this person
Charged
739.00
Total submitted
Denied
205.00
1 denied claims
Patient responsibility
80.10
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 | ELENA HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000867 |
| Date of birth | 20 Oct 1965 |
| Plan | PLATINUM PPO |
| Covered from | 25 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 80.10 |
| Total | 80.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003844 | 28 Jul 2024 | 534.00 | CASCADE CARE | Not denied | — |
| CLM0003843 | 3 May 2024 | 205.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 205.00 |