KEVIN FOSTER
Dependent on policy B04M000299
Claims
2
Attributed to this person
Charged
875.00
Total submitted
Denied
396.17
2 denied claims
Patient responsibility
39.00
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 | KEVIN FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000299 |
| Date of birth | 5 Mar 2006 |
| Plan | GOLD PPO |
| Covered from | 19 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 39.00 |
| Total | 39.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001298 | 4 Jul 2025 | 815.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 396.17 |
| CLM0001297 | 1 May 2025 | 60.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |