DAVID TANAKA
Dependent on policy B05M000660
Claims
3
Attributed to this person
Charged
2,272.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
179.20
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 | DAVID TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000660 |
| Date of birth | 11 Feb 1969 |
| Plan | GOLD PPO |
| Covered from | 14 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 179.20 |
| Total | 179.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002849 | 30 Jul 2026 | 567.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002848 | 4 Aug 2024 | 896.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002847 | 4 Jul 2024 | 809.00 | MERIDIAN HEALTH PLAN | Not denied | — |