DAVID TANAKA
Subscriber on policy B01M000761
Claims
1
Attributed to this person
Charged
617.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
92.55
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 TANAKA |
| Role on the policy | Subscriber |
| Policy | B01M000761 |
| Date of birth | 9 Jan 1986 |
| Plan | PLATINUM PPO |
| Covered from | 6 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 92.55 |
| Total | 92.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003390 | 6 Apr 2024 | 617.00 | MERIDIAN HEALTH PLAN | Not denied | — |