SOFIA YAMADA
Dependent on policy B04M000392
Claims
3
Attributed to this person
Charged
1,855.00
Total submitted
Denied
1,367.00
2 denied claims
Patient responsibility
73.20
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 | SOFIA YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000392 |
| Date of birth | 28 Oct 2015 |
| Plan | SILVER HMO |
| Covered from | 3 Sep 2024 |
| Covered to | 11 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 73.20 |
| Total | 73.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001693 | 24 Apr 2025 | 733.00 | CASCADE CARE | CARC 18 · DUPLICATE | 733.00 |
| CLM0001695 | 16 Jan 2025 | 488.00 | CASCADE CARE | Not denied | — |
| CLM0001694 | 14 Oct 2024 | 634.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 634.00 |