ZARA USMAN
Dependent on policy B03M000301
Claims
1
Attributed to this person
Charged
110.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
22.00
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 | ZARA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000301 |
| Date of birth | 27 Nov 2015 |
| Plan | SILVER HMO |
| Covered from | 24 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 22.00 |
| Total | 22.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001203 | 19 Jun 2025 | 110.00 | CASCADE CARE | Not denied | — |