WENDY REYES
Subscriber on policy B03M000746
Claims
1
Attributed to this person
Charged
448.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
67.20
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 | WENDY REYES |
| Role on the policy | Subscriber |
| Policy | B03M000746 |
| Date of birth | 10 Dec 1950 |
| Plan | PLATINUM PPO |
| Covered from | 17 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 67.20 |
| Total | 67.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003129 | 5 Feb 2025 | 448.00 | CASCADE CARE | Not denied | — |