YUSUF TANAKA
Subscriber on policy B02M000287
Claims
1
Attributed to this person
Charged
835.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
167.00
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 | YUSUF TANAKA |
| Role on the policy | Subscriber |
| Policy | B02M000287 |
| Date of birth | 14 Sep 1969 |
| Plan | SILVER HMO |
| Covered from | 19 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 167.00 |
| Total | 167.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001231 | 29 Jan 2024 | 835.00 | MERIDIAN HEALTH PLAN | Not denied | — |