LEILA ANDERSON
Dependent on policy B10M000654
Claims
2
Attributed to this person
Charged
580.00
Total submitted
Denied
401.00
1 denied claims
Patient responsibility
26.85
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 | LEILA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000654 |
| Date of birth | 25 Sep 1987 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 2025 |
| Covered to | 18 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 26.85 |
| Total | 26.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002714 | 11 Apr 2025 | 179.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002713 | 17 Mar 2025 | 401.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 401.00 |