GRACE FOSTER
Subscriber on policy B05M000557
Claims
2
Attributed to this person
Charged
922.00
Total submitted
Denied
392.00
1 denied claims
Patient responsibility
79.50
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 FOSTER |
| Role on the policy | Subscriber |
| Policy | B05M000557 |
| Date of birth | 7 Oct 1958 |
| Plan | PLATINUM PPO |
| Covered from | 30 Mar 2024 |
| Covered to | 9 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 79.50 |
| Total | 79.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002380 | 26 Oct 2024 | 530.00 | CASCADE CARE | Not denied | — |
| CLM0002379 | 20 Oct 2024 | 392.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 392.00 |