LEILA REYES
Dependent on policy B10M000195
Claims
3
Attributed to this person
Charged
1,060.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
152.75
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 | LEILA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000195 |
| Date of birth | 15 Apr 1989 |
| Plan | GOLD PPO |
| Covered from | 21 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 152.75 |
| Total | 152.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000806 | 25 Apr 2026 | 589.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000805 | 23 Apr 2025 | 235.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000807 | 5 Oct 2024 | 236.00 | MERIDIAN HEALTH PLAN | Not denied | — |