GRACE REYES
Dependent on policy B08M000182
Claims
1
Attributed to this person
Charged
625.00
Total submitted
Denied
625.00
1 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 | GRACE REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000182 |
| Date of birth | 5 Mar 2015 |
| Plan | GOLD PPO |
| Covered from | 12 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000819 | 27 Oct 2024 | 625.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 625.00 |