LEILA USMAN
Dependent on policy B03M000807
Claims
2
Attributed to this person
Charged
1,028.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
60.45
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 | LEILA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000807 |
| Date of birth | 5 Jun 1989 |
| Plan | SILVER HMO |
| Covered from | 17 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 60.45 |
| Total | 60.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003475 | 22 Oct 2025 | 403.00 | CASCADE CARE | Not denied | — |
| CLM0003474 | 22 Mar 2025 | 625.00 | CASCADE CARE | Not denied | — |