HENRY PATEL
Dependent on policy B04M000647
Claims
1
Attributed to this person
Charged
361.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
234.65
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 | HENRY PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000647 |
| Date of birth | 25 Feb 1976 |
| Plan | GOLD PPO |
| Covered from | 26 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 234.65 |
| Total | 234.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002822 | 17 Aug 2025 | 361.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |