DAVID REYES
Dependent on policy B06M000720
Claims
3
Attributed to this person
Charged
1,571.00
Total submitted
Denied
746.00
2 denied claims
Patient responsibility
273.65
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 | DAVID REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000720 |
| Date of birth | 13 May 1945 |
| Plan | PLATINUM PPO |
| Covered from | 19 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 273.65 |
| Total | 273.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003225 | 17 Aug 2026 | 404.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003224 | 28 May 2026 | 746.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 746.00 |
| CLM0003226 | 22 Dec 2025 | 421.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |