OMAR TANAKA
Dependent on policy B02M000795
Claims
1
Attributed to this person
Charged
593.00
Total submitted
Denied
593.00
1 denied claims
Patient responsibility
0.00
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 | OMAR TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000795 |
| Date of birth | 15 Apr 2003 |
| Plan | GOLD PPO |
| Covered from | 26 Jan 2025 |
| Covered to | 18 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003329 | 19 May 2025 | 593.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 593.00 |