TOMAS REYES
Dependent on policy B09M000443
Claims
2
Attributed to this person
Charged
621.00
Total submitted
Denied
500.59
2 denied claims
Patient responsibility
0.00
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 | TOMAS REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000443 |
| Date of birth | 20 Feb 2020 |
| Plan | PLATINUM PPO |
| Covered from | 19 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001866 | 19 Jul 2025 | 228.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 107.59 |
| CLM0001865 | 5 Mar 2025 | 393.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 393.00 |