ZARA REYES
Subscriber on policy B08M000090
Claims
3
Attributed to this person
Charged
2,045.00
Total submitted
Denied
517.00
1 denied claims
Patient responsibility
15.00
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 | ZARA REYES |
| Role on the policy | Subscriber |
| Policy | B08M000090 |
| Date of birth | 2 Mar 1992 |
| Plan | BRONZE EPO |
| Covered from | 12 Mar 2025 |
| Covered to | 20 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000401 | 16 Nov 2025 | 517.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 517.00 |
| CLM0000402 | 12 Nov 2025 | 644.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000403 | 28 Oct 2025 | 884.00 | MERIDIAN HEALTH PLAN | Not denied | — |