LEILA REYES
Subscriber on policy B02M000455
Claims
1
Attributed to this person
Charged
128.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
83.20
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 REYES |
| Role on the policy | Subscriber |
| Policy | B02M000455 |
| Date of birth | 18 Apr 1975 |
| Plan | BRONZE EPO |
| Covered from | 4 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 83.20 |
| Total | 83.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001938 | 11 Nov 2024 | 128.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |