IVAN HUGHES
Dependent on policy B04M000727
Claims
3
Attributed to this person
Charged
2,053.00
Total submitted
Denied
782.00
1 denied claims
Patient responsibility
117.40
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 | IVAN HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000727 |
| Date of birth | 16 Nov 2014 |
| Plan | PLATINUM PPO |
| Covered from | 13 Feb 2024 |
| Covered to | 29 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 117.40 |
| Total | 117.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003175 | 5 May 2024 | 587.00 | CASCADE CARE | Not denied | — |
| CLM0003176 | 23 Apr 2024 | 684.00 | CASCADE CARE | Not denied | — |
| CLM0003174 | 22 Jan 2024 | 782.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 782.00 |