CARLA QUINN
Dependent on policy B06M000749
Claims
3
Attributed to this person
Charged
1,369.00
Total submitted
Denied
413.00
1 denied claims
Patient responsibility
191.20
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 QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000749 |
| Date of birth | 5 Dec 1962 |
| Plan | GOLD PPO |
| Covered from | 21 Jan 2024 |
| Covered to | 11 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 2 | 191.20 |
| Total | 191.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003330 | 25 Mar 2024 | 400.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003328 | 27 Dec 2023 | 556.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003329 | 26 Dec 2023 | 413.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 413.00 |