ZARA REYES
Dependent on policy B02M000455
Claims
1
Attributed to this person
Charged
448.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
291.20
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 | ZARA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000455 |
| Date of birth | 18 Dec 1968 |
| Plan | BRONZE EPO |
| Covered from | 4 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 291.20 |
| Total | 291.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001939 | 25 Sep 2025 | 448.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |