IVAN KUMAR
Subscriber on policy B04M000345
Claims
3
Attributed to this person
Charged
1,699.00
Total submitted
Denied
741.00
2 denied claims
Patient responsibility
136.50
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 | IVAN KUMAR |
| Role on the policy | Subscriber |
| Policy | B04M000345 |
| Date of birth | 21 Aug 1987 |
| Plan | GOLD PPO |
| Covered from | 11 Jun 2025 |
| Covered to | 30 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 136.50 |
| Total | 136.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001490 | 17 Aug 2025 | 210.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0001489 | 25 Jun 2025 | 748.00 | CASCADE CARE | Not denied | — |
| CLM0001491 | 5 Jun 2025 | 741.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 741.00 |