TOMAS ANDERSON
Subscriber on policy B05M000809
Claims
1
Attributed to this person
Charged
740.00
Total submitted
Denied
740.00
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 ANDERSON |
| Role on the policy | Subscriber |
| Policy | B05M000809 |
| Date of birth | 7 Jan 1981 |
| Plan | GOLD PPO |
| Covered from | 13 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003435 | 27 May 2026 | 740.00 | CASCADE CARE | CARC 96 · NON_COVERED | 740.00 |