GRACE PATEL
Dependent on policy B05M000533
Claims
2
Attributed to this person
Charged
171.00
Total submitted
Denied
67.00
1 denied claims
Patient responsibility
20.00
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 | GRACE PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000533 |
| Date of birth | 22 Feb 2015 |
| Plan | BRONZE EPO |
| Covered from | 9 Apr 2025 |
| Covered to | 11 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002273 | 8 Sep 2025 | 104.00 | CASCADE CARE | Not denied | — |
| CLM0002272 | 14 Jul 2025 | 67.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 67.00 |