GRACE TANAKA
Dependent on policy B04M000011
Claims
1
Attributed to this person
Charged
312.00
Total submitted
Denied
312.00
1 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 | GRACE TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000011 |
| Date of birth | 9 Sep 1995 |
| Plan | BRONZE EPO |
| Covered from | 23 Feb 2025 |
| Covered to | 11 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000055 | 9 Feb 2025 | 312.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 312.00 |