CARLA TANAKA
Dependent on policy B06M000249
Claims
2
Attributed to this person
Charged
1,131.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
162.50
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 | CARLA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000249 |
| Date of birth | 4 Jul 1979 |
| Plan | BRONZE EPO |
| Covered from | 20 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 162.50 |
| Total | 162.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001185 | 22 Nov 2025 | 250.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001184 | 12 Nov 2025 | 881.00 | MERIDIAN HEALTH PLAN | Not denied | — |