OMAR ANDERSON
Dependent on policy B04M000614
Claims
3
Attributed to this person
Charged
1,165.00
Total submitted
Denied
841.00
2 denied claims
Patient responsibility
48.60
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000614 |
| Date of birth | 24 Jul 1959 |
| Plan | GOLD PPO |
| Covered from | 9 Jan 2024 |
| Covered to | 11 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 48.60 |
| Total | 48.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002686 | 10 Jun 2024 | 558.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 558.00 |
| CLM0002684 | 16 Apr 2024 | 283.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 283.00 |
| CLM0002685 | 13 Mar 2024 | 324.00 | CASCADE CARE | Not denied | — |