SOFIA TANAKA
Subscriber on policy B03M000470
Claims
3
Attributed to this person
Charged
633.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | SOFIA TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000470 |
| Date of birth | 10 Jan 1960 |
| Plan | SILVER HMO |
| Covered from | 9 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001947 | 3 Jun 2026 | 240.00 | CASCADE CARE | Not denied | — |
| CLM0001946 | 15 May 2026 | 127.00 | CASCADE CARE | Not denied | — |
| CLM0001948 | 4 May 2025 | 266.00 | CASCADE CARE | Not denied | — |