GRACE YAMADA
Dependent on policy B03M000613
Claims
1
Attributed to this person
Charged
510.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
76.50
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 | GRACE YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000613 |
| Date of birth | 6 Jul 1999 |
| Plan | SILVER HMO |
| Covered from | 10 Jan 2024 |
| Covered to | 4 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 76.50 |
| Total | 76.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002522 | 6 Feb 2024 | 510.00 | MERIDIAN HEALTH PLAN | Not denied | — |