TOMAS IQBAL
Dependent on policy B03M000123
Claims
3
Attributed to this person
Charged
575.00
Total submitted
Denied
87.00
2 denied claims
Patient responsibility
213.85
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 IQBAL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000123 |
| Date of birth | 14 Mar 1973 |
| Plan | PLATINUM PPO |
| Covered from | 26 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 213.85 |
| Total | 213.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000486 | 16 Apr 2025 | 159.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000487 | 7 Mar 2025 | 329.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000485 | 5 Mar 2025 | 87.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 87.00 |