LEILA TANAKA
Dependent on policy B03M000374
Claims
2
Attributed to this person
Charged
843.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
59.55
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 | LEILA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000374 |
| Date of birth | 26 Jul 2006 |
| Plan | GOLD PPO |
| Covered from | 4 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 59.55 |
| Total | 59.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001523 | 28 May 2025 | 397.00 | CASCADE CARE | Not denied | — |
| CLM0001522 | 8 Mar 2025 | 446.00 | CASCADE CARE | Not denied | — |