ELENA REYES
Subscriber on policy B02M000163
Claims
1
Attributed to this person
Charged
673.00
Total submitted
Denied
673.00
1 denied claims
Patient responsibility
0.00
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 REYES |
| Role on the policy | Subscriber |
| Policy | B02M000163 |
| Date of birth | 26 Jan 1952 |
| Plan | BRONZE EPO |
| Covered from | 7 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000737 | 14 Jan 2025 | 673.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 673.00 |