LEILA USMAN
Dependent on policy B10M000777
Claims
3
Attributed to this person
Charged
1,794.00
Total submitted
Denied
926.00
2 denied claims
Patient responsibility
0.00
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 | LEILA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000777 |
| Date of birth | 25 Apr 1995 |
| Plan | SILVER HMO |
| Covered from | 24 Apr 2024 |
| Covered to | 7 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003256 | 12 Sep 2024 | 640.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 640.00 |
| CLM0003257 | 3 Aug 2024 | 868.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003255 | 6 Apr 2024 | 286.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 286.00 |