ZARA TANAKA
Subscriber on policy B03M000108
Claims
2
Attributed to this person
Charged
1,054.00
Total submitted
Denied
548.00
1 denied claims
Patient responsibility
101.20
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 | ZARA TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000108 |
| Date of birth | 6 Jan 1978 |
| Plan | GOLD PPO |
| Covered from | 10 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 101.20 |
| Total | 101.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000429 | 24 Dec 2025 | 548.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 548.00 |
| CLM0000430 | 14 Mar 2025 | 506.00 | CASCADE CARE | Not denied | — |