VICTOR USMAN
Dependent on policy B10M000320
Claims
2
Attributed to this person
Charged
364.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
31.05
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 | VICTOR USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000320 |
| Date of birth | 8 Apr 1953 |
| Plan | BRONZE EPO |
| Covered from | 21 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.05 |
| Total | 31.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001346 | 15 Jan 2025 | 157.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001347 | 6 Dec 2024 | 207.00 | MERIDIAN HEALTH PLAN | Not denied | — |