SOFIA REYES
Subscriber on policy B10M000744
Claims
3
Attributed to this person
Charged
1,772.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
544.70
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 | SOFIA REYES |
| Role on the policy | Subscriber |
| Policy | B10M000744 |
| Date of birth | 3 Nov 1967 |
| Plan | BRONZE EPO |
| Covered from | 11 Oct 2024 |
| Covered to | 26 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 544.70 |
| Total | 544.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003125 | 18 Feb 2025 | 462.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003124 | 4 Jan 2025 | 472.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003126 | 28 Oct 2024 | 838.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |