ELENA TANAKA
Dependent on policy B04M000507
Claims
3
Attributed to this person
Charged
1,953.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | ELENA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000507 |
| Date of birth | 18 Oct 2013 |
| Plan | GOLD PPO |
| Covered from | 8 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002181 | 8 Nov 2025 | 309.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002183 | 15 Aug 2025 | 876.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002182 | 21 May 2025 | 768.00 | MERIDIAN HEALTH PLAN | Not denied | — |