PRIYA USMAN
Dependent on policy B02M000841
Claims
3
Attributed to this person
Charged
1,437.00
Total submitted
Denied
467.00
1 denied claims
Patient responsibility
25.00
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 | PRIYA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000841 |
| Date of birth | 26 Jul 1976 |
| Plan | GOLD PPO |
| Covered from | 8 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003503 | 1 Jul 2025 | 659.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003501 | 28 Nov 2024 | 467.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 467.00 |
| CLM0003502 | 8 Oct 2024 | 311.00 | MERIDIAN HEALTH PLAN | Not denied | — |