ELENA USMAN
Subscriber on policy B07M000194
Claims
1
Attributed to this person
Charged
841.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
168.20
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 | ELENA USMAN |
| Role on the policy | Subscriber |
| Policy | B07M000194 |
| Date of birth | 15 May 1991 |
| Plan | BRONZE EPO |
| Covered from | 7 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 168.20 |
| Total | 168.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000805 | 10 Aug 2026 | 841.00 | MERIDIAN HEALTH PLAN | Not denied | — |