ELENA USMAN
Subscriber on policy B07M000873
Claims
3
Attributed to this person
Charged
1,480.00
Total submitted
Denied
987.00
2 denied claims
Patient responsibility
0.00
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 | ELENA USMAN |
| Role on the policy | Subscriber |
| Policy | B07M000873 |
| Date of birth | 2 Jan 1993 |
| Plan | PLATINUM PPO |
| Covered from | 5 Oct 2024 |
| Covered to | 28 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003609 | 22 Dec 2024 | 629.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 629.00 |
| CLM0003610 | 3 Dec 2024 | 493.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003608 | 2 Oct 2024 | 358.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 358.00 |