AMARA USMAN
Dependent on policy B02M000133
Claims
1
Attributed to this person
Charged
644.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
418.60
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 | AMARA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000133 |
| Date of birth | 16 Nov 2000 |
| Plan | PLATINUM PPO |
| Covered from | 9 Feb 2025 |
| Covered to | 20 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 418.60 |
| Total | 418.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000608 | 16 Apr 2025 | 644.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |