HENRY HUGHES
Dependent on policy B03M000360
Claims
3
Attributed to this person
Charged
1,609.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
124.15
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 | HENRY HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000360 |
| Date of birth | 11 Feb 2004 |
| Plan | PLATINUM PPO |
| Covered from | 10 Sep 2024 |
| Covered to | 10 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 124.15 |
| Total | 124.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001456 | 27 May 2025 | 749.00 | CASCADE CARE | Not denied | — |
| CLM0001455 | 7 Nov 2024 | 669.00 | CASCADE CARE | Not denied | — |
| CLM0001454 | 31 Aug 2024 | 191.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |