UMA IQBAL
Dependent on policy B04M000806
Claims
2
Attributed to this person
Charged
314.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
15.15
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 | UMA IQBAL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000806 |
| Date of birth | 5 Apr 2002 |
| Plan | GOLD PPO |
| Covered from | 30 Aug 2024 |
| Covered to | 7 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 15.15 |
| Total | 15.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003519 | 3 Nov 2024 | 101.00 | CASCADE CARE | Not denied | — |
| CLM0003520 | 12 Oct 2024 | 213.00 | CASCADE CARE | Not denied | — |