CARLA TANAKA
Dependent on policy B02M000795
Claims
1
Attributed to this person
Charged
492.00
Total submitted
Denied
492.00
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 | CARLA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000795 |
| Date of birth | 25 May 2015 |
| 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 |
|---|---|---|---|---|---|
| CLM0003330 | 12 Nov 2025 | 492.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 492.00 |