WENDY USMAN
Dependent on policy B01M000022
Claims
2
Attributed to this person
Charged
852.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
444.80
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 | WENDY USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000022 |
| Date of birth | 3 Apr 2002 |
| Plan | SILVER HMO |
| Covered from | 9 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 412.10 |
| CARC 1 · Deductible | 1 | 32.70 |
| Total | 444.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000084 | 18 Aug 2026 | 218.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000083 | 24 May 2025 | 634.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |