GRACE IQBAL
Dependent on policy B04M000300
Claims
3
Attributed to this person
Charged
1,936.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
198.00
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 IQBAL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000300 |
| Date of birth | 24 Jun 2022 |
| Plan | SILVER HMO |
| Covered from | 24 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 158.00 |
| CARC 3 · Copay | 1 | 40.00 |
| Total | 198.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001304 | 24 Jun 2026 | 276.00 | CASCADE CARE | Not denied | — |
| CLM0001305 | 16 May 2026 | 790.00 | CASCADE CARE | Not denied | — |
| CLM0001306 | 17 Nov 2025 | 870.00 | CASCADE CARE | Not denied | — |