TOMAS PATEL
Dependent on policy B02M000823
Claims
2
Attributed to this person
Charged
1,226.00
Total submitted
Denied
667.00
1 denied claims
Patient responsibility
15.00
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 | TOMAS PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000823 |
| Date of birth | 18 Nov 1945 |
| Plan | PLATINUM PPO |
| Covered from | 23 Dec 2024 |
| Covered to | 13 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003423 | 4 Feb 2025 | 559.00 | CASCADE CARE | Not denied | — |
| CLM0003424 | 30 Dec 2024 | 667.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 667.00 |