GRACE HUGHES
Dependent on policy B03M000781
Claims
2
Attributed to this person
Charged
1,504.00
Total submitted
Denied
1,168.05
2 denied claims
Patient responsibility
0.00
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 | GRACE HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000781 |
| Date of birth | 30 Aug 1954 |
| Plan | GOLD PPO |
| Covered from | 23 Aug 2024 |
| Covered to | 18 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003312 | 7 Apr 2025 | 860.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 860.00 |
| CLM0003311 | 24 Aug 2024 | 644.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 308.05 |