ZARA REYES
Subscriber on policy B10M000303
Claims
2
Attributed to this person
Charged
1,142.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
346.45
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 | ZARA REYES |
| Role on the policy | Subscriber |
| Policy | B10M000303 |
| Date of birth | 6 Feb 1954 |
| Plan | GOLD PPO |
| Covered from | 28 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 346.45 |
| Total | 346.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001266 | 21 Oct 2024 | 533.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0001265 | 16 Aug 2024 | 609.00 | MERIDIAN HEALTH PLAN | Not denied | — |