SOFIA REYES
Dependent on policy B09M000548
Claims
2
Attributed to this person
Charged
789.00
Total submitted
Denied
492.00
1 denied claims
Patient responsibility
59.40
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 REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000548 |
| Date of birth | 17 Dec 2009 |
| Plan | BRONZE EPO |
| Covered from | 18 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 59.40 |
| Total | 59.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002313 | 22 Aug 2026 | 297.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002312 | 8 Apr 2025 | 492.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 492.00 |