HENRY YAMADA
Subscriber on policy B10M000588
Claims
2
Attributed to this person
Charged
1,204.00
Total submitted
Denied
655.00
2 denied claims
Patient responsibility
356.85
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 | HENRY YAMADA |
| Role on the policy | Subscriber |
| Policy | B10M000588 |
| Date of birth | 28 Jan 1989 |
| Plan | PLATINUM PPO |
| Covered from | 4 Apr 2024 |
| Covered to | 22 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 356.85 |
| Total | 356.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002430 | 19 Jul 2024 | 655.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 655.00 |
| CLM0002431 | 24 Apr 2024 | 549.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |