DAVID USMAN
Subscriber on policy B02M000719
Claims
3
Attributed to this person
Charged
1,454.00
Total submitted
Denied
45.05
2 denied claims
Patient responsibility
521.30
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 | DAVID USMAN |
| Role on the policy | Subscriber |
| Policy | B02M000719 |
| Date of birth | 23 Aug 1980 |
| Plan | BRONZE EPO |
| Covered from | 25 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 521.30 |
| Total | 521.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003018 | 21 Jul 2025 | 802.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003017 | 5 Dec 2024 | 222.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 45.05 |
| CLM0003019 | 13 Oct 2024 | 430.00 | CASCADE CARE | Not denied | — |