IVAN USMAN
Subscriber on policy B03M000807
Claims
2
Attributed to this person
Charged
1,376.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
106.80
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B03M000807 |
| Date of birth | 6 Sep 1957 |
| Plan | SILVER HMO |
| Covered from | 17 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 106.80 |
| Total | 106.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003470 | 4 Jul 2025 | 534.00 | CASCADE CARE | Not denied | — |
| CLM0003469 | 20 Oct 2024 | 842.00 | CASCADE CARE | Not denied | — |