TOMAS REYES
Subscriber on policy B04M000349
Claims
1
Attributed to this person
Charged
292.00
Total submitted
Denied
292.00
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 | TOMAS REYES |
| Role on the policy | Subscriber |
| Policy | B04M000349 |
| Date of birth | 4 Feb 2003 |
| Plan | PLATINUM PPO |
| Covered from | 13 Jun 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 |
|---|---|---|---|---|---|
| CLM0001497 | 20 Jan 2025 | 292.00 | CASCADE CARE | CARC 18 · DUPLICATE | 292.00 |