CARLA REYES
Subscriber on policy B02M000819
Claims
2
Attributed to this person
Charged
1,650.00
Total submitted
Denied
819.00
1 denied claims
Patient responsibility
30.00
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 | CARLA REYES |
| Role on the policy | Subscriber |
| Policy | B02M000819 |
| Date of birth | 21 Aug 1972 |
| Plan | PLATINUM PPO |
| Covered from | 20 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003403 | 10 Aug 2026 | 819.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 819.00 |
| CLM0003404 | 20 Jun 2025 | 831.00 | MERIDIAN HEALTH PLAN | Not denied | — |