CARLA PATEL
Dependent on policy B04M000481
Claims
3
Attributed to this person
Charged
1,164.00
Total submitted
Denied
275.00
1 denied claims
Patient responsibility
147.40
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 | CARLA PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000481 |
| Date of birth | 8 Nov 2001 |
| Plan | SILVER HMO |
| Covered from | 12 Sep 2024 |
| Covered to | 27 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 147.40 |
| Total | 147.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002059 | 6 Apr 2025 | 275.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 275.00 |
| CLM0002058 | 27 Feb 2025 | 152.00 | CASCADE CARE | Not denied | — |
| CLM0002060 | 23 Dec 2024 | 737.00 | CASCADE CARE | Not denied | — |