ELENA PATEL
Subscriber on policy B02M000158
Claims
2
Attributed to this person
Charged
1,255.00
Total submitted
Denied
829.00
1 denied claims
Patient responsibility
40.00
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 | ELENA PATEL |
| Role on the policy | Subscriber |
| Policy | B02M000158 |
| Date of birth | 25 Jun 1998 |
| Plan | SILVER HMO |
| Covered from | 8 May 2025 |
| Covered to | 29 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000711 | 8 Sep 2025 | 426.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000712 | 21 Apr 2025 | 829.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 829.00 |