OMAR PATEL
Dependent on policy B04M000400
Claims
3
Attributed to this person
Charged
1,448.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
247.65
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 | OMAR PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000400 |
| Date of birth | 13 Nov 1968 |
| Plan | PLATINUM PPO |
| Covered from | 2 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 247.65 |
| Total | 247.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001722 | 8 Jan 2026 | 228.00 | CASCADE CARE | Not denied | — |
| CLM0001723 | 15 Jul 2025 | 381.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001721 | 18 Aug 2024 | 839.00 | CASCADE CARE | Not denied | — |