IVAN USMAN
Dependent on policy B07M000873
Claims
2
Attributed to this person
Charged
961.00
Total submitted
Denied
269.32
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 | IVAN USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000873 |
| Date of birth | 19 Jun 1997 |
| 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 |
|---|---|---|---|---|---|
| CLM0003611 | 13 Dec 2024 | 316.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 113.27 |
| CLM0003612 | 20 Oct 2024 | 645.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 156.05 |