BRIAN HUGHES
Dependent on policy B02M000749
Claims
1
Attributed to this person
Charged
828.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
538.20
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 | BRIAN HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000749 |
| Date of birth | 31 Oct 2012 |
| Plan | GOLD PPO |
| Covered from | 1 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 538.20 |
| Total | 538.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003145 | 17 Jun 2024 | 828.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |