HENRY USMAN
Dependent on policy B03M000027
Claims
1
Attributed to this person
Charged
815.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
529.75
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 | HENRY USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000027 |
| Date of birth | 23 Aug 2021 |
| Plan | SILVER HMO |
| Covered from | 25 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 529.75 |
| Total | 529.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000133 | 20 Apr 2026 | 815.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |