FIONA TANAKA
Subscriber on policy B03M000374
Claims
3
Attributed to this person
Charged
1,607.00
Total submitted
Denied
655.00
1 denied claims
Patient responsibility
41.60
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 | FIONA TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000374 |
| Date of birth | 18 Jul 1974 |
| Plan | GOLD PPO |
| Covered from | 4 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| CARC 2 · Coinsurance | 1 | 16.60 |
| Total | 41.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001517 | 22 Feb 2026 | 869.00 | CASCADE CARE | Not denied | — |
| CLM0001519 | 26 Aug 2025 | 83.00 | CASCADE CARE | Not denied | — |
| CLM0001518 | 31 Dec 2024 | 655.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 655.00 |