AMARA HUGHES
Subscriber on policy B04M000727
Claims
3
Attributed to this person
Charged
1,678.00
Total submitted
Denied
639.00
2 denied claims
Patient responsibility
211.25
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 | AMARA HUGHES |
| Role on the policy | Subscriber |
| Policy | B04M000727 |
| Date of birth | 9 Jan 1981 |
| Plan | PLATINUM PPO |
| Covered from | 13 Feb 2024 |
| Covered to | 29 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 211.25 |
| Total | 211.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003167 | 19 Jun 2024 | 639.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 639.00 |
| CLM0003168 | 17 Jun 2024 | 325.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003166 | 20 May 2024 | 714.00 | CASCADE CARE | Not denied | — |