GRACE PATEL
Subscriber on policy B04M000201
Claims
1
Attributed to this person
Charged
773.00
Total submitted
Denied
773.00
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 PATEL |
| Role on the policy | Subscriber |
| Policy | B04M000201 |
| Date of birth | 17 Jan 1979 |
| Plan | PLATINUM PPO |
| Covered from | 1 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000895 | 29 Aug 2024 | 773.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 773.00 |