NADIA REYES
Dependent on policy B05M000815
Claims
3
Attributed to this person
Charged
1,530.00
Total submitted
Denied
474.00
2 denied claims
Patient responsibility
106.60
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 | NADIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000815 |
| Date of birth | 2 Dec 1982 |
| Plan | BRONZE EPO |
| Covered from | 6 Jul 2024 |
| Covered to | 9 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 106.60 |
| Total | 106.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003465 | 22 Jan 2025 | 474.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 474.00 |
| CLM0003464 | 23 Nov 2024 | 892.00 | CASCADE CARE | Not denied | — |
| CLM0003463 | 18 Sep 2024 | 164.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |