CARLA KUMAR
Dependent on policy B05M000539
Claims
3
Attributed to this person
Charged
1,107.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
254.70
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 | CARLA KUMAR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000539 |
| Date of birth | 10 May 1950 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 187.20 |
| CARC 1 · Deductible | 1 | 67.50 |
| Total | 254.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002296 | 20 Jul 2025 | 288.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002297 | 26 Apr 2025 | 369.00 | CASCADE CARE | Not denied | — |
| CLM0002298 | 19 Mar 2025 | 450.00 | CASCADE CARE | Not denied | — |