WENDY USMAN
Subscriber on policy B03M000268
Claims
1
Attributed to this person
Charged
174.00
Total submitted
Denied
174.00
1 denied claims
Patient responsibility
0.00
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 | WENDY USMAN |
| Role on the policy | Subscriber |
| Policy | B03M000268 |
| Date of birth | 26 Nov 1985 |
| Plan | PLATINUM PPO |
| Covered from | 16 Jun 2024 |
| Covered to | 28 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001079 | 29 Dec 2024 | 174.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 174.00 |