OMAR PATEL
Subscriber on policy B05M000302
Claims
3
Attributed to this person
Charged
1,055.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
361.40
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 | OMAR PATEL |
| Role on the policy | Subscriber |
| Policy | B05M000302 |
| Date of birth | 25 May 1983 |
| Plan | GOLD PPO |
| Covered from | 10 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 361.40 |
| Total | 361.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001254 | 29 Mar 2026 | 182.00 | CASCADE CARE | Not denied | — |
| CLM0001256 | 15 Dec 2024 | 317.00 | CASCADE CARE | Not denied | — |
| CLM0001255 | 6 Sep 2024 | 556.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |