TOMAS PATEL
Subscriber on policy B09M000680
Claims
1
Attributed to this person
Charged
612.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
397.80
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 PATEL |
| Role on the policy | Subscriber |
| Policy | B09M000680 |
| Date of birth | 6 Jul 1967 |
| Plan | SILVER HMO |
| Covered from | 27 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 397.80 |
| Total | 397.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002893 | 14 May 2025 | 612.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |