CARLA ANDERSON
Dependent on policy B01M000252
Claims
2
Attributed to this person
Charged
1,346.00
Total submitted
Denied
538.00
2 denied claims
Patient responsibility
525.20
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 | CARLA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000252 |
| Date of birth | 6 Aug 2007 |
| Plan | GOLD PPO |
| Covered from | 30 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 525.20 |
| Total | 525.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001073 | 12 Aug 2026 | 808.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001072 | 20 Jun 2026 | 538.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 538.00 |