PRIYA REYES
Dependent on policy B10M000565
Claims
2
Attributed to this person
Charged
1,335.00
Total submitted
Denied
569.00
1 denied claims
Patient responsibility
30.00
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 | PRIYA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000565 |
| Date of birth | 19 Apr 1985 |
| Plan | GOLD PPO |
| Covered from | 28 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002337 | 9 Mar 2025 | 766.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002338 | 23 Feb 2024 | 569.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 569.00 |