KEVIN ANDERSON
Subscriber on policy B02M000027
Claims
1
Attributed to this person
Charged
738.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
479.70
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 ANDERSON |
| Role on the policy | Subscriber |
| Policy | B02M000027 |
| Date of birth | 21 Oct 1980 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 479.70 |
| Total | 479.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000143 | 8 Sep 2024 | 738.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |