WENDY USMAN
Dependent on policy B01M000199
Claims
1
Attributed to this person
Charged
153.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
99.45
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 | WENDY USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000199 |
| Date of birth | 10 Mar 1983 |
| Plan | SILVER HMO |
| Covered from | 27 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 99.45 |
| Total | 99.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000851 | 23 May 2025 | 153.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |