KEVIN REYES
Subscriber on policy B09M000548
Claims
3
Attributed to this person
Charged
1,632.00
Total submitted
Denied
857.00
2 denied claims
Patient responsibility
341.75
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 | KEVIN REYES |
| Role on the policy | Subscriber |
| Policy | B09M000548 |
| Date of birth | 12 Dec 1968 |
| Plan | BRONZE EPO |
| Covered from | 18 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 321.75 |
| CARC 3 · Copay | 1 | 20.00 |
| Total | 341.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002309 | 30 Jul 2026 | 857.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 857.00 |
| CLM0002308 | 23 Mar 2026 | 280.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002307 | 13 Nov 2024 | 495.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |