DAVID PATEL
Subscriber on policy B05M000623
Claims
2
Attributed to this person
Charged
1,539.00
Total submitted
Denied
731.00
1 denied claims
Patient responsibility
161.60
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 | DAVID PATEL |
| Role on the policy | Subscriber |
| Policy | B05M000623 |
| Date of birth | 2 May 1997 |
| Plan | BRONZE EPO |
| Covered from | 29 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 161.60 |
| Total | 161.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002679 | 7 Apr 2025 | 808.00 | CASCADE CARE | Not denied | — |
| CLM0002678 | 17 Feb 2025 | 731.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 731.00 |