ELENA USMAN
Subscriber on policy B01M000194
Claims
3
Attributed to this person
Charged
1,709.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
55.20
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B01M000194 |
| Date of birth | 14 Sep 1953 |
| Plan | GOLD PPO |
| Covered from | 19 Feb 2024 |
| Covered to | 3 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.20 |
| Total | 55.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000827 | 23 Oct 2024 | 368.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000829 | 5 Oct 2024 | 874.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000828 | 3 Jul 2024 | 467.00 | MERIDIAN HEALTH PLAN | Not denied | — |