TOMAS HUGHES
Dependent on policy B03M000781
Claims
3
Attributed to this person
Charged
1,120.00
Total submitted
Denied
433.00
2 denied claims
Patient responsibility
186.55
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 | TOMAS HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000781 |
| Date of birth | 15 Oct 1988 |
| Plan | GOLD PPO |
| Covered from | 23 Aug 2024 |
| Covered to | 18 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 186.55 |
| Total | 186.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003314 | 17 May 2025 | 433.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 433.00 |
| CLM0003313 | 6 Mar 2025 | 400.00 | CASCADE CARE | Not denied | — |
| CLM0003315 | 17 Oct 2024 | 287.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |