ELENA TANAKA
Subscriber on policy B06M000068
Claims
1
Attributed to this person
Charged
778.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.70
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 | ELENA TANAKA |
| Role on the policy | Subscriber |
| Policy | B06M000068 |
| Date of birth | 24 Nov 1994 |
| Plan | GOLD PPO |
| Covered from | 20 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.70 |
| Total | 116.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000362 | 1 Sep 2024 | 778.00 | MERIDIAN HEALTH PLAN | Not denied | — |