LEILA QUINN
Dependent on policy B02M000043
Claims
2
Attributed to this person
Charged
1,368.00
Total submitted
Denied
217.46
1 denied claims
Patient responsibility
116.55
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 QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000043 |
| Date of birth | 23 Sep 1987 |
| Plan | GOLD PPO |
| Covered from | 22 Apr 2025 |
| Covered to | 8 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.55 |
| Total | 116.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000210 | 17 Nov 2025 | 777.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000211 | 2 Sep 2025 | 591.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 217.46 |