DAVID REYES
Dependent on policy B07M000278
Claims
3
Attributed to this person
Charged
1,372.00
Total submitted
Denied
344.00
1 denied claims
Patient responsibility
30.00
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 | DAVID REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000278 |
| Date of birth | 5 Jun 2011 |
| Plan | SILVER HMO |
| Covered from | 1 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001202 | 30 Apr 2026 | 344.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 344.00 |
| CLM0001204 | 1 Mar 2026 | 535.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001203 | 24 Mar 2025 | 493.00 | MERIDIAN HEALTH PLAN | Not denied | — |