BRIAN ANDERSON
Dependent on policy B04M000614
Claims
2
Attributed to this person
Charged
850.00
Total submitted
Denied
850.00
2 denied claims
Patient responsibility
0.00
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 | BRIAN ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000614 |
| Date of birth | 13 May 2002 |
| Plan | GOLD PPO |
| Covered from | 9 Jan 2024 |
| Covered to | 11 Apr 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002687 | 10 Jun 2024 | 732.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 732.00 |
| CLM0002688 | 18 Apr 2024 | 118.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 118.00 |