LEILA REYES
Subscriber on policy B02M000674
Claims
3
Attributed to this person
Charged
1,564.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
389.35
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 | LEILA REYES |
| Role on the policy | Subscriber |
| Policy | B02M000674 |
| Date of birth | 28 May 1960 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 389.35 |
| Total | 389.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002849 | 13 May 2026 | 762.00 | CASCADE CARE | Not denied | — |
| CLM0002848 | 28 Feb 2026 | 599.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002847 | 22 Sep 2024 | 203.00 | CASCADE CARE | Not denied | — |