UMA ANDERSON
Subscriber on policy B01M000524
Claims
2
Attributed to this person
Charged
710.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
89.60
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 | UMA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B01M000524 |
| Date of birth | 11 Oct 1956 |
| Plan | GOLD PPO |
| Covered from | 22 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 89.60 |
| Total | 89.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002355 | 22 Oct 2024 | 262.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002354 | 5 Sep 2024 | 448.00 | MERIDIAN HEALTH PLAN | Not denied | — |