RAVI TANAKA
Dependent on policy B05M000882
Claims
2
Attributed to this person
Charged
809.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
97.20
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 | RAVI TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000882 |
| Date of birth | 10 Nov 2017 |
| Plan | BRONZE EPO |
| Covered from | 29 Jul 2024 |
| Covered to | 23 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 97.20 |
| Total | 97.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003746 | 18 Nov 2024 | 323.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003745 | 23 Sep 2024 | 486.00 | NORTHSTAR MUTUAL | Not denied | — |