VICTOR REYES
Dependent on policy B08M000291
Claims
1
Attributed to this person
Charged
152.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.40
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 | VICTOR REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000291 |
| Date of birth | 16 Jun 1991 |
| Plan | SILVER HMO |
| Covered from | 7 Sep 2024 |
| Covered to | 24 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 30.40 |
| Total | 30.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001335 | 27 Aug 2024 | 152.00 | MERIDIAN HEALTH PLAN | Not denied | — |