TOMAS ANDERSON
Dependent on policy B01M000451
Claims
2
Attributed to this person
Charged
996.00
Total submitted
Denied
170.00
2 denied claims
Patient responsibility
536.90
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 | TOMAS ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000451 |
| Date of birth | 9 Apr 1979 |
| Plan | GOLD PPO |
| Covered from | 7 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 536.90 |
| Total | 536.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002018 | 21 Dec 2025 | 170.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 170.00 |
| CLM0002017 | 9 Nov 2024 | 826.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |