GRACE PATEL
Dependent on policy B09M000322
Claims
3
Attributed to this person
Charged
1,638.00
Total submitted
Denied
1,082.00
2 denied claims
Patient responsibility
50.00
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 | GRACE PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000322 |
| Date of birth | 30 Sep 1976 |
| Plan | PLATINUM PPO |
| Covered from | 13 Jul 2024 |
| Covered to | 7 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001335 | 11 Nov 2024 | 556.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001334 | 15 Oct 2024 | 306.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 306.00 |
| CLM0001333 | 26 Aug 2024 | 776.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 776.00 |