OMAR REYES
Dependent on policy B01M000517
Claims
2
Attributed to this person
Charged
468.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.40
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 | OMAR REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000517 |
| Date of birth | 5 Dec 2019 |
| Plan | BRONZE EPO |
| Covered from | 5 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 36.40 |
| Total | 36.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002331 | 3 Dec 2025 | 182.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002332 | 22 Oct 2024 | 286.00 | MERIDIAN HEALTH PLAN | Not denied | — |