WENDY USMAN
Subscriber on policy B01M000514
Claims
2
Attributed to this person
Charged
1,247.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
69.80
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 | Subscriber |
| Policy | B01M000514 |
| Date of birth | 21 Nov 1950 |
| Plan | PLATINUM PPO |
| Covered from | 18 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 69.80 |
| Total | 69.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002311 | 25 Dec 2025 | 349.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002313 | 9 Nov 2025 | 898.00 | MERIDIAN HEALTH PLAN | Not denied | — |