ELENA PATEL
Dependent on policy B08M000444
Claims
3
Attributed to this person
Charged
1,109.00
Total submitted
Denied
129.12
2 denied claims
Patient responsibility
177.45
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 | ELENA PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000444 |
| Date of birth | 14 Feb 2013 |
| Plan | SILVER HMO |
| Covered from | 10 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 177.45 |
| Total | 177.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002041 | 19 Dec 2025 | 279.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 129.12 |
| CLM0002043 | 19 Nov 2025 | 557.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002042 | 29 Jul 2025 | 273.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |