GRACE KUMAR
Subscriber on policy B03M000256
Claims
1
Attributed to this person
Charged
255.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | GRACE KUMAR |
| Role on the policy | Subscriber |
| Policy | B03M000256 |
| Date of birth | 6 Apr 1954 |
| Plan | PLATINUM PPO |
| Covered from | 21 Mar 2025 |
| Covered to | 21 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001023 | 24 Jun 2025 | 255.00 | MERIDIAN HEALTH PLAN | Not denied | — |