DAVID ANDERSON
Dependent on policy B03M000167
Claims
3
Attributed to this person
Charged
1,501.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
61.65
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 | DAVID ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000167 |
| Date of birth | 27 May 1985 |
| Plan | SILVER HMO |
| Covered from | 21 Jul 2024 |
| Covered to | 28 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 61.65 |
| Total | 61.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000686 | 1 Sep 2024 | 419.00 | CASCADE CARE | Not denied | — |
| CLM0000685 | 21 Jul 2024 | 411.00 | CASCADE CARE | Not denied | — |
| CLM0000684 | 12 Jul 2024 | 671.00 | CASCADE CARE | Not denied | — |