TOMAS USMAN
Dependent on policy B05M000672
Claims
2
Attributed to this person
Charged
840.00
Total submitted
Denied
140.30
1 denied claims
Patient responsibility
0.00
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000672 |
| Date of birth | 17 Oct 1972 |
| Plan | PLATINUM PPO |
| Covered from | 4 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002898 | 3 May 2026 | 354.00 | CASCADE CARE | Not denied | — |
| CLM0002899 | 17 May 2024 | 486.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 140.30 |