SOFIA IQBAL
Dependent on policy B09M000264
Claims
2
Attributed to this person
Charged
688.00
Total submitted
Denied
111.43
1 denied claims
Patient responsibility
51.15
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 | SOFIA IQBAL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000264 |
| Date of birth | 15 Nov 1965 |
| Plan | SILVER HMO |
| Covered from | 9 Feb 2024 |
| Covered to | 3 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.15 |
| Total | 51.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001090 | 24 May 2024 | 347.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 111.43 |
| CLM0001091 | 5 Mar 2024 | 341.00 | MERIDIAN HEALTH PLAN | Not denied | — |