IVAN TANAKA
Subscriber on policy B03M000796
Claims
2
Attributed to this person
Charged
1,426.00
Total submitted
Denied
646.00
1 denied claims
Patient responsibility
156.00
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 | IVAN TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000796 |
| Date of birth | 9 May 1969 |
| Plan | BRONZE EPO |
| Covered from | 20 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 156.00 |
| Total | 156.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003405 | 22 Dec 2025 | 646.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 646.00 |
| CLM0003406 | 31 May 2024 | 780.00 | CASCADE CARE | Not denied | — |