DAVID HUGHES
Dependent on policy B02M000720
Claims
3
Attributed to this person
Charged
951.00
Total submitted
Denied
200.69
1 denied claims
Patient responsibility
20.00
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 | DAVID HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000720 |
| Date of birth | 13 Jul 1948 |
| Plan | GOLD PPO |
| Covered from | 4 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003023 | 2 Jun 2026 | 553.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 200.69 |
| CLM0003024 | 3 Oct 2025 | 97.00 | CASCADE CARE | Not denied | — |
| CLM0003022 | 6 Mar 2025 | 301.00 | CASCADE CARE | Not denied | — |