LEILA REYES
Subscriber on policy B03M000869
Claims
2
Attributed to this person
Charged
322.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
0.00
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 | LEILA REYES |
| Role on the policy | Subscriber |
| Policy | B03M000869 |
| Date of birth | 29 May 1953 |
| Plan | GOLD PPO |
| Covered from | 18 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003762 | 10 Oct 2024 | 170.00 | CASCADE CARE | Not denied | — |
| CLM0003763 | 14 Jul 2024 | 152.00 | CASCADE CARE | Not denied | — |