IVAN REYES
Dependent on policy B05M000178
Claims
1
Attributed to this person
Charged
244.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.60
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 REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000178 |
| Date of birth | 6 Dec 2006 |
| Plan | PLATINUM PPO |
| Covered from | 4 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 36.60 |
| Total | 36.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000757 | 5 Dec 2025 | 244.00 | CASCADE CARE | Not denied | — |