ELENA ANDERSON
Dependent on policy B04M000046
Claims
3
Attributed to this person
Charged
1,796.00
Total submitted
Denied
1,109.86
2 denied claims
Patient responsibility
49.95
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000046 |
| Date of birth | 29 Aug 1992 |
| Plan | PLATINUM PPO |
| Covered from | 27 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 49.95 |
| Total | 49.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000214 | 20 Jan 2026 | 614.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 260.86 |
| CLM0000215 | 10 Jan 2026 | 333.00 | CASCADE CARE | Not denied | — |
| CLM0000213 | 26 Apr 2025 | 849.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 849.00 |