LEILA REYES
Dependent on policy B09M000018
Claims
3
Attributed to this person
Charged
1,413.00
Total submitted
Denied
203.11
1 denied claims
Patient responsibility
24.75
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 | LEILA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000018 |
| Date of birth | 30 Aug 1983 |
| Plan | PLATINUM PPO |
| Covered from | 11 Jan 2025 |
| Covered to | 3 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 24.75 |
| Total | 24.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000074 | 4 Apr 2025 | 696.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000072 | 19 Mar 2025 | 552.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 203.11 |
| CLM0000073 | 3 Jan 2025 | 165.00 | MERIDIAN HEALTH PLAN | Not denied | — |