HENRY REYES
Subscriber on policy B03M000867
Claims
2
Attributed to this person
Charged
770.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
88.80
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 | HENRY REYES |
| Role on the policy | Subscriber |
| Policy | B03M000867 |
| Date of birth | 9 Jun 1998 |
| Plan | GOLD PPO |
| Covered from | 17 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 88.80 |
| Total | 88.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003759 | 13 Feb 2026 | 592.00 | CASCADE CARE | Not denied | — |
| CLM0003758 | 20 May 2024 | 178.00 | CASCADE CARE | Not denied | — |