SOFIA REYES
Subscriber on policy B03M000373
Claims
1
Attributed to this person
Charged
634.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
412.10
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 | SOFIA REYES |
| Role on the policy | Subscriber |
| Policy | B03M000373 |
| Date of birth | 15 Jul 1968 |
| Plan | PLATINUM PPO |
| Covered from | 30 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 412.10 |
| Total | 412.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001515 | 29 Aug 2025 | 634.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |