TOMAS USMAN
Dependent on policy B01M000514
Claims
2
Attributed to this person
Charged
1,016.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.00
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000514 |
| Date of birth | 26 Feb 1959 |
| Plan | PLATINUM PPO |
| Covered from | 18 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002315 | 24 Jun 2025 | 162.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002314 | 7 May 2025 | 854.00 | MERIDIAN HEALTH PLAN | Not denied | — |