TOMAS PATEL
Subscriber on policy B03M000220
Claims
3
Attributed to this person
Charged
1,777.00
Total submitted
Denied
746.00
1 denied claims
Patient responsibility
90.00
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 PATEL |
| Role on the policy | Subscriber |
| Policy | B03M000220 |
| Date of birth | 25 Nov 1989 |
| Plan | PLATINUM PPO |
| Covered from | 11 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 90.00 |
| Total | 90.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000895 | 19 Oct 2025 | 600.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000897 | 10 Apr 2025 | 431.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000896 | 1 Mar 2025 | 746.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 746.00 |