LEILA REYES
Dependent on policy B04M000387
Claims
3
Attributed to this person
Charged
706.00
Total submitted
Denied
138.00
1 denied claims
Patient responsibility
32.25
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 | LEILA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000387 |
| Date of birth | 27 Jul 1949 |
| Plan | SILVER HMO |
| Covered from | 5 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 32.25 |
| Total | 32.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001661 | 19 Jul 2026 | 353.00 | CASCADE CARE | Not denied | — |
| CLM0001662 | 22 Dec 2025 | 138.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 138.00 |
| CLM0001663 | 7 Jan 2025 | 215.00 | CASCADE CARE | Not denied | — |