DAVID ANDERSON
Subscriber on policy B01M000278
Claims
1
Attributed to this person
Charged
269.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
53.80
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 | DAVID ANDERSON |
| Role on the policy | Subscriber |
| Policy | B01M000278 |
| Date of birth | 21 May 1990 |
| Plan | GOLD PPO |
| Covered from | 20 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 53.80 |
| Total | 53.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001207 | 26 Mar 2026 | 269.00 | MERIDIAN HEALTH PLAN | Not denied | — |