SOFIA FOSTER
Subscriber on policy B02M000336
Claims
1
Attributed to this person
Charged
642.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
417.30
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 | SOFIA FOSTER |
| Role on the policy | Subscriber |
| Policy | B02M000336 |
| Date of birth | 2 Jul 1958 |
| Plan | BRONZE EPO |
| Covered from | 23 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 417.30 |
| Total | 417.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001430 | 17 Oct 2025 | 642.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |