RAVI HUGHES
Dependent on policy B03M000433
Claims
3
Attributed to this person
Charged
2,000.00
Total submitted
Denied
204.77
1 denied claims
Patient responsibility
30.00
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 | RAVI HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000433 |
| Date of birth | 9 Aug 2011 |
| Plan | GOLD PPO |
| Covered from | 27 Mar 2025 |
| Covered to | 29 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001768 | 6 Jun 2025 | 782.00 | CASCADE CARE | Not denied | — |
| CLM0001767 | 14 May 2025 | 867.00 | CASCADE CARE | CARC 96 · NON_COVERED | 204.77 |
| CLM0001769 | 10 Apr 2025 | 351.00 | CASCADE CARE | Not denied | — |