OMAR FOSTER
Subscriber on policy B03M000054
Claims
2
Attributed to this person
Charged
1,149.00
Total submitted
Denied
212.08
1 denied claims
Patient responsibility
55.95
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 FOSTER |
| Role on the policy | Subscriber |
| Policy | B03M000054 |
| Date of birth | 11 Aug 1969 |
| Plan | SILVER HMO |
| Covered from | 24 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.95 |
| Total | 55.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000232 | 6 Feb 2025 | 373.00 | CASCADE CARE | Not denied | — |
| CLM0000233 | 31 May 2024 | 776.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 212.08 |