PRIYA KUMAR
Dependent on policy B03M000159
Claims
1
Attributed to this person
Charged
260.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
52.00
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 | PRIYA KUMAR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000159 |
| Date of birth | 23 Jul 2016 |
| Plan | GOLD PPO |
| Covered from | 16 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 52.00 |
| Total | 52.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000653 | 10 Sep 2024 | 260.00 | CASCADE CARE | Not denied | — |