FIONA REYES
Dependent on policy B10M000453
Claims
3
Attributed to this person
Charged
1,927.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
168.00
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 | FIONA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000453 |
| Date of birth | 9 Oct 1992 |
| Plan | PLATINUM PPO |
| Covered from | 10 Jul 2024 |
| Covered to | 22 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 168.00 |
| Total | 168.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001876 | 20 Aug 2024 | 840.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001875 | 6 Aug 2024 | 794.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001877 | 14 Jul 2024 | 293.00 | MERIDIAN HEALTH PLAN | Not denied | — |