JULIA REYES
Dependent on policy B03M000869
Claims
3
Attributed to this person
Charged
1,755.00
Total submitted
Denied
194.00
2 denied claims
Patient responsibility
528.45
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 | JULIA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000869 |
| Date of birth | 28 Jun 1976 |
| Plan | GOLD PPO |
| Covered from | 18 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 528.45 |
| Total | 528.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003769 | 26 Jun 2026 | 194.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 194.00 |
| CLM0003770 | 8 Mar 2026 | 813.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003768 | 5 Nov 2024 | 748.00 | CASCADE CARE | Not denied | — |