WENDY USMAN
Subscriber on policy B08M000879
Claims
2
Attributed to this person
Charged
1,142.00
Total submitted
Denied
149.22
1 denied claims
Patient responsibility
62.10
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 | WENDY USMAN |
| Role on the policy | Subscriber |
| Policy | B08M000879 |
| Date of birth | 19 Jun 1958 |
| Plan | SILVER HMO |
| Covered from | 4 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 62.10 |
| Total | 62.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003927 | 23 Aug 2026 | 728.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 149.22 |
| CLM0003928 | 12 Feb 2025 | 414.00 | MERIDIAN HEALTH PLAN | Not denied | — |