FIONA TANAKA
Subscriber on policy B04M000116
Claims
1
Attributed to this person
Charged
642.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
96.30
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 | FIONA TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000116 |
| Date of birth | 14 Nov 1995 |
| Plan | GOLD PPO |
| Covered from | 19 Apr 2025 |
| Covered to | 27 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 96.30 |
| Total | 96.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000538 | 14 May 2025 | 642.00 | NORTHSTAR MUTUAL | Not denied | — |