GRACE REYES
Subscriber on policy B03M000285
Claims
1
Attributed to this person
Charged
391.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
58.65
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 REYES |
| Role on the policy | Subscriber |
| Policy | B03M000285 |
| Date of birth | 20 Apr 1976 |
| Plan | PLATINUM PPO |
| Covered from | 19 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 58.65 |
| Total | 58.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001130 | 20 Jun 2025 | 391.00 | MERIDIAN HEALTH PLAN | Not denied | — |