UMA FOSTER
Dependent on policy B07M000259
Claims
3
Attributed to this person
Charged
1,995.00
Total submitted
Denied
163.24
1 denied claims
Patient responsibility
126.00
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 | UMA FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000259 |
| Date of birth | 26 Aug 2013 |
| Plan | BRONZE EPO |
| Covered from | 1 Jun 2024 |
| Covered to | 1 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 126.00 |
| Total | 126.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001109 | 11 Sep 2024 | 840.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001108 | 24 Jun 2024 | 716.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001110 | 12 Jun 2024 | 439.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 163.24 |