ELENA PATEL
Subscriber on policy B04M000481
Claims
3
Attributed to this person
Charged
653.00
Total submitted
Denied
196.00
1 denied claims
Patient responsibility
55.35
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 | ELENA PATEL |
| Role on the policy | Subscriber |
| Policy | B04M000481 |
| Date of birth | 25 May 1969 |
| Plan | SILVER HMO |
| Covered from | 12 Sep 2024 |
| Covered to | 27 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.35 |
| Total | 55.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002054 | 7 May 2025 | 196.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 196.00 |
| CLM0002056 | 13 Nov 2024 | 369.00 | CASCADE CARE | Not denied | — |
| CLM0002055 | 24 Oct 2024 | 88.00 | CASCADE CARE | Not denied | — |