JULIA REYES
Dependent on policy B08M000416
Claims
2
Attributed to this person
Charged
1,102.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
132.60
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 | JULIA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000416 |
| Date of birth | 12 Jul 1989 |
| Plan | SILVER HMO |
| Covered from | 12 Mar 2024 |
| Covered to | 8 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 132.60 |
| Total | 132.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001922 | 22 Jul 2024 | 898.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001921 | 11 May 2024 | 204.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |